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CUIDADO É FUNDAMENTAL
UNIVERSIDADE FEDERAL DO ESTADO DO RIO DE JANEIRO . ESCOLA DE ENFERMAGEM ALFREDO PINTO
REVISTA ONLINE DE PESQUISA
J. res.: fundam. care. online 2017. abr./jun. 9(2): 459-465
RESEARCH
CUIDADO É FUNDAMENTAL
UNIVERSIDADE FEDERAL DO ESTADO DO RIO DE JANEIRO . ESCOLA DE ENFERMAGEM ALFREDO PINTO
REVISTA ONLINE DE PESQUISA
DOI: 10.9789/2175-5361.2017.v9i2.459-465
459
DOI: 10.9789/2175-5361.2017.v9i2.459-465 | Badke MR;Heisler EV;Ceolin S; et al. | Nursing students knowledge on...
O conhecimento de discentes de enfermagem sobre uso
de plantas medicinais como terapia complementar1
Nursing students knowledge on use of medicinal plants as
supplementary therapy
Conocimiento de estudiantes de enfermería acerca del uso de las planta
medicinales en la terapia complementaria
Marcio Rossato Badke2; Elisa Vanessa Heisler3; Silvana Ceolin4; Andressa de Andrade5; Maria de Lourdes
Denardin Budó6; Rita Maria Heck7
How to quote this article:
Badke MR;Heisler EV;Ceolin S; et al. Nursing students knowledge on use of medicinal plants
as supplementary therapy. Rev Fund Care Online. 2017 abr/jun; 9(2):459-465. DOI: http://dx.doi.
org/10.9789/2175-5361.2017.v9i2.459-465
ABSTRACT
Objective: To identify the knowledge of nursing students on the use of medicinal plants as a complementary
therapy to health care. Methods: Qualitative research conducted through semi structured interviews with eight
nursing students from a Federal University of Rio Grande do Sul in October 2012. In thematic content analysis,
three categories emerged: “I learned from my family”, “I acknowledge the importance of medicinal plants” and
“I use plants at home, but do not recommend its use in the practical eld”. Results: e knowledge of students
regarding the use of medicinal plants is of popular source. Insecurity has been observed amongst undergraduates
as to their agency as future professionals orienting in the guidelines regarding the use of medicinal plants,
pointing to the need of advances in the nursing education. Conclusion: Highlights the need to review the
nursing syllabuses in order to contemplate the subject, as a mean of promoting health and comprehensive care.
Descriptors: Nursing Care, Medicinal Plants, Nursing, Nursing Education, Culture.
1 Research funded by the National Council for Scientic and Technological Development - CNPq - Brazil.
2 Nurse. Master in Nursing. PhD student of FEn/UFPel. Assistant Professor in the Nursing Department of the Federal University of
Santa Maria (UFSM). E-mail: marciobadke@gmail.com.
3 Nurse. Student of the Post-Graduate Program in Nursing at Federal University of Santa Maria (PPGenf- UFSM).
Email elisa.vanessa@yahoo.com.br.
4 Nurse. PhD student in the Post-Graduate Nursing Program (PPG) in Nursing at College of Nursing (FEN) - Federal University of
Pelotas (UFPel). E-mail: silvanaceolin@gmail.com.
5 Nurse. Master in Health Sciences. Assistant Professor of the Health Sciences Department at Federal University of Santa Maria
(UFSM). E-mail: andressaufsm@gmail.com.
6 Nurse. PhD. Professor of the Department and Graduate Program at Federal University of Santa Maria Nursing (UFSM). E-mail:
lourdesdenardin@gmail.com.
7 Nurse. PhD in Nursing. Associate Professor of FEn/UFPel. E-mail: rmheckpillon@yahoo.com.br.
ISSN 2175-5361. DOI: 10.9789/2175-5361.2017.v9i2.459-465
Badke MR;Heisler EV;Ceolin S; et al. Nursing students knowledge on...
J. res.: fundam. care. online 2017. abr./jun. 9(2): 459-465 460
RESUMO
Objetivo: Investigar o conhecimento de discentes de enfermagem
sobre o uso de plantas medicinais como terapia complementar no
cuidado da saúde. Métodos: Pesquisa qualitativa, realizada por meio
de entrevista semiestruturada com oito acadêmicos de enfermagem em
uma Universidade Federal do Rio Grande do Sul em outubro de 2012.
Na análise de conteúdo, emergiram três temas: “aprendi em família”;
“reconheço a importância das plantas medicinais” e “uso as plantas
em casa, mas não estimulo o uso em campo prático”. Resultados: O
conhecimento dos discentes referente ao uso de plantas medicinais é de
origem popular. Observou-se a insegurança que os graduandos possuem
frente à atuação como futuros prossionais nas orientações referentes ao
uso das plantas medicinais, apontando à necessidade de avançar no ensino
de enfermagem. Conclusão: Destaca-se a necessidade de revisão nos
currículos para que deem suporte sobre o tema, com vistas à promoção da
saúde e a integralidade do cuidado.
Descritores: Cuidados de Enfermagem, Plantas Medicinais, Enfermagem,
Educação em Enfermagem, Cultura.
RESUMEN
Objetivo: Identicar el conocimiento de los estudiantes de enfermería
en el uso de plantas medicinales como terapia complementaria a
la asistencia sanitaria. Método: Estudio cualitativo realizado con
entrevistas semiestructuradas con ocho estudiantes de enfermería de
una Universidad Federal de Rio Grande do Sul, en octubre de 2012. En el
análisis de contenido, surgieron tres categorías: “aprendí con mi familia”,
“sé de la importancia del uso de las plantas” y “uso plantas en casa, pero
no estimuló el uso en campo práctico”. Resultados: El conocimiento de
los estudiantes sobre el uso de plantas medicinales es de fuente popular.
Observado la inseguridad que los estudiantes tienen en orientar, como
futuros profesionales, las directrices relativas a la utilización de las plantas
medicinales, se apunta a la necesidad de avanzar en la formación de
enfermería. Conclusión: Pone de relieve la necesidad de revisar los planes
de estudios que dan apoyo en el tema, cuyo objetivo es promover la salud
y la atención integral.
Descriptores: Cuidado de Enfermería, Plantas Medicinales, Enfermería,
Educación en Enfermería, Cultura.
INTRODUCTION
e use of medicinal plants and phytotherapics has been
growing within the public health care system1, demonstrating
the recognition of popular knowledge within the scientic
eld. In Brazil, as of 2006, the use of medicinal plants has
been legitimized as part of the process of patient care,
through the perspective of complementation of the ocial
actions in health care. Nonetheless, gaps are still noticeable
in the academic formation of health professionals, for, as
studies show2, 79% of professionals in the health area are
not acquainted with the medicinal plants thematic and/or
complementary therapies during their academic formation.
In spite of this gap, the World Health Organization3
estimates that 80% of the world population uses medicinal
plants in health care, rectifying the distanciation between
the formation of the professionals and the reality of
the population.
is disaccord between the reality of the population and
the academic formation is due to the guidelines of education
present in the undergraduate nursing school, as well as in the
other health science careers, which are based on a positivist
view of the world and of the human being. Given that the
formation is based on conceptions imposed by the biomedical
model of health, nurses tend to depreciate the popular
knowledge concerning health because popular practices are
generally based on observation and experimentation, not in
scientic evidence.4
Aer a long time on the sidelines of the ocial Brazilian
health care system, medicinal plants have managed to earn
some space. e VIII National Health Conference in 1986
was a starting point for the development of complementary
therapies and medicinal plants related policies. e
rectifying of this initiative occurred in 2006 through the
implementation of the National Policy for Integrative and
Complementary Practices and the National Policy for
Medicinal Plants and Phytotherapics, which encourages
the use of medicinal plants in health care and supports the
formation and permanent education of health professionals
on the subject of this thematic.
Promoted by this normalization, the Resolution nº
695/13, approved in Rio Grande do Sul (RS) the State’s Policy
on Integrative and Complementary Practices, intended to
implement the PICs in Brazils Universal health care System
(SUS)/RS, incorporating the practices already established
in the system, aimed at the promotion, prevention and
assistance, all health related matters, based on integrative
principles and targeting the humanization of procedures and
actions in all attention levels.1
However, in order for this process to be eective, the
insertion of medicinal plants in health care needs to occur
in a safe manner, therefore the professionals must have
knowledge on the pharmacological eects and toxicity of
the plants.5
From this perspective, the Brazillian Federal Nursing
Council (COFEn), through the Resolution 197/97, establishes
and recognizes the alternative therapies as specialties and/
or qualications of the nurse, as long as one has concluded
and has been approved in class or congener entity, with a
minimum workload of 360 hours.6
Besides the complementary formation, it is necessary
that professionals of the health science career acquire, in
their formation, knowledge on medicinal plants. To that
end, it is necessary that the universities include on their
syllabuses disciplines that focus on the study of medicinal
plants in order to bring care practices closer to the reality
of the population and of the Brazil’s Universal Health Care
System (SUS).7,8
us, this article aims to investigate the knowledge
of nursing students on the use of medicinal plants as a
complementary therapy on health care.
ISSN 2175-5361. DOI: 10.9789/2175-5361.2017.v9i2.459-465
Badke MR;Heisler EV;Ceolin S; et al. Nursing students knowledge on...
J. res.: fundam. care. online 2017. abr./jun. 9(2): 459-465 461
METHODS
e study is of an exploratory and descriptive nature,
structured from a qualitative research. is, on its turn,
deepens itself on the world of signication, of essence,
of human relations, of attitudes, of belief and value,
hence, exploring a reality that can not be captured by
quantitative data. 9
e Nursing undergraduate class of a Federal University
of Rio Grande do Sul was used as a spatial indicator to ken
the knowledge and practices of nursing students on the use
of medicinal plants as a health care complementary therapy.
e gathering of the data occurred in a classroom at this
particular University, through a semistructured interview,
realized with eight senior undergraduates, in October 2012,
with day and time preestablished.
e semistructured interview “must be constructed in a
way that allows exibility in the conversation and that absorbs
new themes and questions brought by the interlocutor as a
relevant structure”.9:191
For this study, an interview script composed by two parts
has been prepared; the rst contains ten objective questions
on personal data of the participants, such as sex, age, and
other things, this information was useful to trace a prole
of the researched participants. e second part consists
of twelve subjective questions, that approach mainly the
knowledge the participant has on medicinal plants, how
they acquired this knowledge, a comparison between the
experience they had with the use of plants and the use of
allopathic medicine, as well an inquiry if they make use of
medicinal plants to care for their own health and of their
family, or if they use and recommend the use of plants in
their practices or academic internships.
e subjects of the study were chosen through the
technique of simple casual selection.10 Participants were
interviewed up until the point when the goals of the research
were achieved, completing a total of eight students. e
criteria for inclusion in the research were: to be a senior
undergraduate in Nursing and to live in the urban area of the
city of the researched University. To assure the anonymity
of the participants, the code S followed by the number of
the order in which the interview occurred was used in the
presentation of the results.
e data analysis contemplated the thematic analysis
proposed by Bardin.11 It is considered one of the content
analysis techniques, its operalisation is distinguished in three
stages: pre-analysis; exploration of the material; and the
treatment of results, regarding inference and interpretation.
e results were organized on emerging issues, according
to the participant’s speeches: “I learned from my family”, “I
acknowledge the importance of medicinal plants” and “I
use plants at home, but do not recommend its use in the
practical eld.”
It is noteworthy that all ethical principles applicable
to human research were respected. e research subjects
signed the Free and Enlightened Consent Form. e article
is in accordance with Ministry of Health (MS) Resolution
196 of October 10th 1996, which denes the legal principles
for research with human beings.12
is project was approved by the Ethics Committee of
the Federal University of Santa Maria, under number 129945
and CAAE 07550812.7.0000.5346.
RESULTS AND DISCUSSION
is topic presents the study results starting with the
characterization of the participants, and, next, with the
presentation of themes built from the thematic analysis of
the material.
Characterization of the participants
e participants of the study were eight students of
the last semester of Nursing undergraduate school, their
ages ranged from 21 to 40 years old. e vast majority of
respondents were women, which shows that nursing is
still a predominantly female major. It is believed that this
predominance of the female sex is by the perpetuation of the
belief that the woman is the caregiver par excellence, given
that, culturally, she is the one who cares for the family. 13
“I learned from my family”
When asked of the students: “how did you start using
medicinal plants?”, It was observed that the meaning
they attach to the use of medicinal plants is related to the
knowledge and experience they have gained from their
families, especially their mothers and grandmothers. e
transmission of knowledge on medicinal plants is sustained
by the relation of aection between the women-mother
gure and the child, in an attempt to pass the knowledge
on to the next generation.14 e rst contact with the use of
medicinal plants was, according to respondents, aimed at
the cure of diseases. ese experiences were mentioned as of
great signicance, because satisfactory results were reported,
which encouraged the subjects to use plants routinely. ese
are examples that can be observed in the speeches of some
respondents, who are very clear to point out the household
as the source of their knowledge.
“[...] I started because of my mother, ever since I was a
child, she would tell me to take a cup of tea of this, a cup
of tea of that [...]” (S1)
“In fact, I started using [medicinal plants] when I was
a kid, my mother forced me to take some teas. And it’s
kind of a habit of her to make tea for the u, tea for other
things.” (S2)
ISSN 2175-5361. DOI: 10.9789/2175-5361.2017.v9i2.459-465
Badke MR;Heisler EV;Ceolin S; et al. Nursing students knowledge on...
J. res.: fundam. care. online 2017. abr./jun. 9(2): 459-465 462
I” started to use [medicinal plants] at home with my
mother and my grandparents [...] I use them because I
have seen [good] results.”(S3)
e statements show that contact with medicinal plants
begins within the family. In accordance with this nding, a
study conducted in 2009 showed that the construction of
knowledge related to the use of medicinal plants by farmers
families is predominantly oral, conducted through daily
interaction between its members, providing the transmission
of information, beliefs and values, also shared amongst the
other members of the community to which they belong.15
ere is a manifestation in the statements of the
respondents that supports the idea that women have always
had the role of caretaker within their families since the
beginning of civilization. is nding corroborates the
study conducted with residents of the coverage area of a
Family Health Unit, in which a close relationship becomes
evident between women and the plants, for their use was the
main therapeutic resource used to treat people’s health and
of their families.14
e care of the family members is usually assigned
to women, and this female predominance highlights the
importance of women in the transmission of knowledge
between generations and the responsibility for the
implementation of health care in the family, making use of
medicinal plants for its realization.15
“I acknowledge the importance of
medicinal plants”
When asked if they used medicinal plants on a daily
basis, all respondents said they used them, and when asked
them to make a comparison between the use of allopathic
medicine and the use of medicinal plants, it became evident
that the respondents knew how to dierentiate them, as
observed if the following lines :
“e plants are there, you do not need to purchase them
[lower cost], are within reach [easy to obtain] [...] as of the
ecacy, plants have always been eective in my use.” (S4)
“In fact, I believe that plants have fewer side eects than
the drugs we buy.” (S1)
“I believe one takes the medicine from the pharmacy and
one complements it with plants because it actually helps
to alleviate the problem.” (S5)
“[...] Here is what I think: pharmacy drugs, as they are
studied, they are put into practice (tested), (therefore), I
think the eects are faster. While complementary therapy
I think it is great too. [...] Also it (complementary therapy)
is a treatment for a long time [...]” (S6)
Respondents consider that medicinal plants are of easier
access than allopathic drugs, implicate in lower economic
costs and lower health risks, therefore, complement
the allopathic treatment. Regarding allopathic drugs,
respondents mentioned it shows eects in a fast manner,
as plants, on the other hand, must be consumed for a long
period of time to show results.
In line with what was mentioned in the statements
above, on May 3rd 2006 the National Policy on Integrative
and Complementary Practices (PNPIC) in SUS was created,
established by Ordinance nº 971 of the Ministry of Health
(MS) aiming to expand the therapeutic options available to
SUS users, amongst these, medicinal plants, guaranteeing
access to herbal medicines and herbal medicine-related
services, with safety, ecacy and quality, according to the
perspective of integrative health care. Adding to this, it was
established in 2007 the National Program for Medicinal
Plants and Herbal medicines, which aims to “ensure safe
access and rational use of medicinal and herbal plants to
the Brazilian population, promoting the sustainable use of
biodiversity, the development of the productive chain and
the domestic industry”.16:7
In order to achieve its goal, amongst the propositions
of the Program just mentioned, there is one to “promote
and recognize the popular and traditional practices of use
of medicinal plants, herbal and home remedies.16:7 us, in
February 2009, the Ministry of Health issued the National
List of Medicinal Plants of Interest to the SUS (Renisus), in
which are present 71 plant species used by popular wisdom
and conrmed scientically.17
It is believed that the care provided by means of medicinal
plants is favorable to human health, since the user has prior
knowledge of their purpose, risks and benets. In addition,
health professionals, especially nurses, should consider such
popular source as a resource in their care practice, enabling
a singular care, focused on the beliefs, values and lifestyle of
the people cared for.18
It is known that the plants should be used with caution
for its use can cause harm just as any industrialized drug.
What determines the eect of a plant is the context in which
it is used, its preparation and dosage and the concepts of
health and disease of a particular culture. When a plant is
used outside of this context, it can produce unwanted and
unexpected eects.19
To make proper use of plants, it is necessary to go through
a thorough research on the subject in order to acquire the
necessary knowledge and, thus, attain the healing of the
acquired disease.
“I use plants at home, but do not recommend
its use in the practical field”
During the data collection, the respondents were asked if
they encouraged the use of medicinal plants at home and/or
practical elds. From the responses, it was noticeable that all
of them encourage the use of plants in their homes, however,
ISSN 2175-5361. DOI: 10.9789/2175-5361.2017.v9i2.459-465
Badke MR;Heisler EV;Ceolin S; et al. Nursing students knowledge on...
J. res.: fundam. care. online 2017. abr./jun. 9(2): 459-465 463
they do not feel at ease to recommend its use while practicing
in their professional internships:
“[...] In my house yes, we use them constantly. But not in
practical activities and internships. [...]” (S6)
“At home yes. Not at internships.” (S5)
is nding is consistent with the study, which mentions
that the use of medicinal plants is a current practice within
the health professionals daily routine, but absent in their
workspace.20 is absence is justied in a study that points
out the insecurity shown by the professionals who feel
unable to prescribe the use of medicinal plants due to the
scarce dissemination of its scientic validation.21
However, considering that the care prescribed and
developed by nurses aims at solving problems listed by the
nursing and health sta, the theme medicinal plants lies
duly in their professional area. erefore, with advances
in new studies and the equipping of nurses with scientic
tools and popular knowledge, the process of prescribing and
indicating the use of medicinal plants will be carried out by
the professional category.22
It is noteworthy that the standard-setting entity of the
profession, the Federal Nursing Council (COFEN) approved
the Resolution 197/97, that contains Art. 1 which establishes
and recognizes alternative therapies as a specialty and/or
qualication of nursing professionals.6
Another question asked to the students was if they
“considered themselves able to work with medicinal plants
aer graduation”, all were unanimous in answering that
they do not consider themselves able or self-condent to
encourage the use of medicinal plants in their care practices,
as can be found in the following lines:
“[...] I do not consider myself [able to work with medicinal
plants] because as I told you, what I know is a matter
of popular knowledge. Nothing scientic. [...] I would be
apprehensive in prescribing them to people because I do
not know the exact quantities [...]” (S6)
In this regard, ANVISA through Resolution RDC nº
267/200523 made public the list of plant species and parts
of plant species permitted for use by the population, which
endorsed greater legal support to the form of preparation
and proper use of medicinal plants.
“[...] No because I think it has to be more specic. We
learned it supercially [the theme of medicinal plants in
graduation].” (S5)
“[...] I do not consider myself apt. I think we still have a lot
to learn, I mean, at graduation, we learn the basics, a slight
sense of what it is, but not enough to be prepared [...]” (S7)
Reinforcing this nding, there is a study also performed
with nursing students, which showed that most students
never discussed complementary therapies with teachers.
is research also reinforces that if knowledge about
complementary therapies such as the use of medicinal plants
is obtained, for the most part, outside the academic world,
its professional indication can not be guided by common
sense but by scientic guidelines, as expected for any nursing
intervention or prescription.24
Research indicates the importance of professional
improvement on the subject medicinal plants and the
insertion of these therapies in their work place.25 erefore,
the assembly of a syllabus that incorporates the popular
practices of care is an essential piece of the puzzle that would
enable the nurse to scientically support the knowledge
about medicinal plants and indicate their use safely and
eectively to the assisted population.
When asked respondents if the same had contact with the
subject of complementary therapies, the lack of encouragement
given to students by the curriculum of universities appears
once again, in regards of complementary therapies and
specically the medicinal plants in their daily work:
“We had a class on alternative therapies where we talked
about various therapies, including that one, herbal
medicine, right?” (S8)
“In the 4th semester we had some classes on
complementary therapies such as plants, reiki [...] but it
was only supercial, nothing concrete.” (S5)
“[...] I once had a class [in college], it wasn’t even on
complementary therapy,it was on alternative therapy
that they spoke of plants. But I do not remember, it was
only once a long time ago.” (S2)
e speech of the respondents refers, once again, to the
fragility of university education, as popular knowledge in
health care remains on the margins of scienticity as it is
recognized by the biomedical model.4 is way, the nurse
tends to reproduce this model uncritically, disregarding
sometimes, other possible manifestation of knowledge on
health, such as those resulting from popular wisdom.4 is
might explain the fact that, despite having been published
in 05/04/2006, Ordinance nº 971 of the Ministry of Health
that established the PNPIC is still unknown by many
health professionals.20
Justifying, once again, the need to incorporate the issue
into the syllabuses of universities, for the use of medicinal
ISSN 2175-5361. DOI: 10.9789/2175-5361.2017.v9i2.459-465
Badke MR;Heisler EV;Ceolin S; et al. Nursing students knowledge on...
J. res.: fundam. care. online 2017. abr./jun. 9(2): 459-465 464
plants as a complementary health therapy, because it is not
clearly discussed in classes nor trained during activities in the
practice eld, for the course syllabus does not contemplate
the approach on complementary therapies, in spite of the
existence of COFEN’s resolution, which gives nurses the use
of medicinal plants as one of its specialties.
erefore, nursing should appropriate the study of
medicinal plants and encourage its use in hospitals and
in Family Health Strategy (ESF) as one more option for
treatment for the health of its members, exchanging
information with users on how they use plants and allow this
approach between popular and scientic knowledge.
CONCLUSION
With this research, we observed that the respondents
believe in the ecacy of medicinal plants through the
experiences and information exchanged with their families,
which occurs mainly with mothers and grandmothers,
showing the permanence of the female gure in health care.
e study also highlights a weakness in the undergraduate
nursing syllabuses, which is still very focused on the
biomedical model, compromising the integral formation of
students. With education disassociated from the reality of
the population, student and future nursing professional tend
to devalue popular knowledge in the use of medicinal plants,
which impairs the user’s autonomy in health care.
e statements of the students also show that they feel
insecure to oer guidance to users of medicinal plants
without scientic basis. So, it is important that the academy
gives support on the whole process covering the care of
plants: from farming to consumption.
In acting as a student and nursing professional, one needs
to view the user in their culture, seeking to approach scient ic
and popular knowledge. is congruence is essential and
necessary to remove the medicinal plants from the periphery
of scienticity as it is recognized by the biomedical model.
Both forms of knowledge add up when one aspires to health
promotion and integrative care.
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Badke MR;Heisler EV;Ceolin S; et al. Nursing students knowledge on...
J. res.: fundam. care. online 2017. abr./jun. 9(2): 459-465 465
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Received on: 19/02/2016
Reviews required: No
Approved on: 15/06/2016
Published on: 10/04/2017
_________
Author responsible for correspondence:
Marcio Rossato Badke
Rua Gomes Carneiro, 01, 2o andar – Sala 208
Pelotas/RS. Brazil
Telefone: (53) 3284-3823.
Email: marciobadke@gmail.com
ZIP-code: 96.015-000
