RESEARCH ARTICLES
Popular practices in health: self-care to wounds of users of medicinal plants
Rudval Souza da SilvaI; Laíse Souza Lima MatosII; Ednaldo Cavalcante de AraújoIII; Gilvânia Patrícia do Nascimento PaixãoIV; Laura Emmanuela Lima CostaV; Álvaro PereiraVI
INurse. Mater and PhD in Nursing by the Post-Graduation Program of the Nursing School of the Federal University of Bahia. Scholarship Coordination of Improvement of Higher Education Personnel. Assistant Professor of the State University of Bahia - Campus VII. Salvador, Bahia, Brazil. E-mail: rudvalsouza@yahoo.com.br.
IINurse. Graduated by the State University of Bahia - Campus VII. Senhor do Bonfim, Bahia, Brazil. E-mail: lslmatos@hotmail.com.
IIINurse. Post-PhD by the Université de Sorbonne, Paris, France. Graduation Professor and of the Post-Graduation Program in Nursing, Health Science Center, of the Federal University of Pernambuco. Recife, Pernambuco, Brazil. E-mail: ednenjp@gmail.com.
IVNurse. Master and PhD in Nursing by the Post-Graduation Program in Nursing of the Federal University of Bahia. Assistant Professor of the State University of Bahia/Campus VII. Senhor do Bonfim, Bahia, Brazil. E-mail: gilvania.paixao@gmail.com
VNurse. Master in Nursing by the Post-Graduation Program in Nursing of the Federal University of Bahia. Assistant Professor of the State University of Bahia/Campus IV. Jacobina, Bahia, Brazil. E-mail: manuela.jacobina@gmail.com
VINurse. PhD in Nursing Philosophy by the Federal University of Santa Catarina. IV Adjunct Professor of the Post-Graduation Program in Nursing from the Nursing School of the Federal University of Bahia. Salvador, Bahia, Brazil. E-mail: alvaro_pereira_ba@yahoo.com.br
ABSTRACT: This prospective and descriptive research aimed at assessing popular practice of wound care adopted by members of a family attending a Family Health Unit in the municipality of Senhor do Bonfim, Bahia, Northeast Brazil, with nine users registered. Data was collected from interviews held from June to August, 2012 and were analyzed on the basis of Bardin’s content analysis. Two categories emerged: [1] using popular practices in wound care; and [2] wound care: an empirical and generational learning. Conclusions show that those practices were traditionally passed on across generations and social life dynamics with the female figure at the center of that transmission chain. Practices rely strongly on medicinal plants, with a stronghold in the community.
Keywords: Nursing care; wound closure techniques; complementary therapies; primary health care.
INTRODUCTION
There is a tendency of health professionals to delineate the concept of wound only from the physical aspects. The physical wounds have characteristics such as psychological, social, spiritual, cultural and biological dimensions.
A wound is a physical injury in the body-subject causing suffering to the person and often does not need any sensory stimulus to feel the pain related to the wound, since the suffering from the physical wound can be a result of a mark, a hurt, an irreparable loss, or even an incurable disease1. The stigmas in people with wound may be visible or not, generating emotional and/or social problems in their lives.
In this sense, among the practices of caring for people with wounds, there are the popular health practices, even in the technological revolution and the growth of the pharmaceutical industry. Studies2,3 show that 66% of the Brazilian population does not have access to medicine because of the high cost, so data from the Ministry of Health3 show 62.9% of Brazilians using complementary practices, such as the popular practices of wound care.
In this perspective, it is necessary that health professionals are open to new possibilities of care practices combining popular practices to the traditional ones, besides estimable value to the less advantaged social groups.
The patients and their families at home complemented many of the guidelines provided by nurses to treat the wounds, using popular practices. The non-acceptance of guidance given by nurses was because of an attitude of superiority adopted by these professionals in relation to the guidelines provided, leaving the patient to the edge of their own care, excluding their autonomy in decision making for taking care of themselves4.
This study arose from observations during the practical activities in a family health unit (FHU) and aimed to know the popular practice of wound care adopted by users of this unit, in a city in the interior of Bahia/Northeast of Brazil.
THEORETHICAL REFERENCIAL
Thinking of the popular practice of care to people with wounds, we need to enhance respect for their autonomy, because biological wounds are part of a body-subject, inserted in a transcultural context and their care have to consider all the dimensions. It is necessary to discuss care practices in their social, cultural context, quality of life and human dignity of people with wounds.
From the moment a person is born, it is necessary to develop care for life´s continuity. Human existence is possible only when there is care5.6. Thus, from this sense, it arises different aspects enabling discussions regarding care: human care is proper to men, so there is not human existence without some care.
Historically the attitudes of care are more common in female figure, but in some way, every human being develops unique ways to care, because the starting point for the first human experiences related to care occurs when starting their own lives, within home, receiving the warmth and affection of the family. In it, they formed roots, values and knowledge, including care knowledge5.6.
When speaking of nursing care, there are peculiarities related to care, based on the knowledge developed, of a scientific nature, which is defined7 as professional nursing care. This care should be an act directed the completeness of the human being, from a set of acts, immersed in a social, spiritual and cultural context respecting the particularities of each person, family and community.
In nursing care practice is possible to keep the cultural care of the patient when their practices help and not interfere with the health-disease process. Sometimes negotiate it through dialogue between the scientific and professional knowledge of the cultural user, adjusting them in order to obtain satisfactory results or even restructure it when patient care practices do not favor the restoration of their health7.
Based on the Theory of Cultural Diversity and Universality of Care7, proposed by Madeleine Leininger, a study of people with wounds, classified care into two subsystems: the popular care from people, transmitted through the generations, and care professional, arising from technical and scientific knowledge8.
Thus, each person has a particular way to face certain situations, and this has a direct link with the cultural influence of each person. Therefore, when someone suffers injury ending in an injury, he will have their peculiar ways of care, with reflections of his own history and culture8.9.
Therefore, when discussing care in a cultural perspective, it is imperative to emphasize the principle of individual autonomy. It is very common during the disease process people feel vulnerable and need special care of their families, friends and professionals. It is the time when the person is vulnerable and open to different types of care, their beliefs dissipate or enliven, and depending on the degree of weakness, many pathophysiological processes start happening. The disease is not an experience limited to biological processes, but also cultural construction in which the user will own perceptions about their illness10.
In a integrality perspective, the cultural care comes from the nurse´s humanistic and scientific knowledge together with the experiences, sufferings, hopes and expectations of the user11. This is to respect the autonomy of others and strengthen relations between professional and user contradicting the idea that there is unworthiness of professional expertise, but there is an overrun of paternalistic dimension in order to remain diverse, plural relationship, recognizing and respecting the subject of the therapeutic process - the user. If this integral and human approach do not permeate the professional-patient relationship therapeutic success, they will have lower chances therefore they will end up treading opposite paths12.
In this perspective of transcultural care, taking into account the respect for the subject´s autonomy, the use of the popular practices in wound care has its place as a therapeutic resource. The use of medicinal plants, ancient practice that came from the accumulation of empirical knowledge passing through generations, is actually one of the features most used by the population. This is because of its easy access, low cost and practice used for prevention as well as for healing and relief from sickness, passed from father to son, consisting therefore in a generational care representative and a significant fraction of the culture of a community13-15. Thus, the practice of care for the wounds have not limited the medical prescriptions, but instead complemented and sometimes even restricted popular practices.
METHODOLOGY
This is a descriptive and prospective study conducted between June and August 2012 in a town of FHU in Senhor do Bonfim - Bahia Northeast of Brazil. The CEP of UNEB under protocol No. 105.111/2012 and CAAE 04178012.7.0000.0057 approved it.
The sample had random selection and the number of employees chosen according to the saturation of responses. This occurs when the shared information from the interviewees' statements become repetitive16. People with wounds, registered at FHU were in the study; of both genders; with more than 18 years old and agreed to participate in the study by signing the informed consent form (ICF). The selection of subjects was from the contact with the community health agents who serve the enrolled FHU allowing the identification of users.
The study population consisted of nine members of FHU with any skin injury - wound. Among these, six were female and three males, between 20 and 80 years old. With regard to religion, eight users declared to be Catholics, and only one referred to have no religion. To identify the respondents, while respecting the anonymity, they have names of medicinal plants mentioned by users. We used the following codenames: Carobinha, Mastruz, Aroeira, Romã, Cedro, Barbatimão, Jurubeba, Cajueiro Branco e Jurema.
For data analysis we used the content analysis technique17, so that the data were grouped allowing the basis for the construction of discussions about the topic.
RESULTS AND DISCUSSION
From the analysis two categories emerged - Use of popular practices in the care of wounds and Caring for wounds: an empirical and generational learning.
Use of popular practices in the care of wounds
Despite popular practice in care of wounds are often ignored by health professionals, in the community of the study, there is adherence by users of FHU and mostly based on the use of medicinal plants, an ancient practice , passed from father to son.
Of the nine respondents, six reported using the popular practice of wounds care; five of these make use of herbal medicine, showing the importance and the cultural influence they have in the community.
The complementary and integrative health practices, like the use of herbal and medicinal plants, currently recognized by the World Health Organization (WHO), and in Brazil, since the 1980s producing many works to encourage use of herbal and medicinal plants at USF, including a regulation of the Ministry of Health (MOH) for the use of complementary and integrative health practices3.
Users have confirmed the use of medicinal plants in the wounds, five used the popular practices claiming they were effective in the care of wounds. Of these five, two added that the results of these practices were more promising than medicine. We ca noted in the following statement:
I took medicine from the doctor, but it was not the medicine the doctor gave me that who healed me [...] I was cured with jurubeba herb that taught me to use it. 15 days I was cured. (Jurubeba)
It is noticed that there is a testimony to the faith using the popular health practices (use of medicinal plants), contributing to the wound cure, considering the influence of the spiritual dimension in the care of wounds.
These popular beliefs cause people to get answers to questions and concerns about wounds, showing why the search for such alternatives18.
I say: if the medicine will not kill or harm me [...], it was God who made them, it is natural, then I'll do it [use the juice of jurubeba], then I took it and I did it! There were 15 days of my daughter, and believe in God, [...] that leg was healed. (Jurubeba)
Even though there are evidences of scientific methods healing, this will be a spiritual dimension. The cure in this cultural context is above all, a supernatural action, thus surpassing the physical dimension19.
Users describe how they prepare the medicinal plants to use them, since the active principle is extracted to obtain its medicinal properties.
I washed it well, crimped, grabbed a white cloth, I put two folds [...] I squeezed [the juice of jurubeba], and put in a bowl. (Jurubeba)
So: roasting [aroeira, barbatimão romã], crimping and lay upon. Others make the bath and bathe. (Aroeira)
There was the preparation of the plants from the roasting process from the skin or fruit then they crimped it, obtaining the powder and only then, apply it to the wound. Only two mentioned that also bathe the wound with an infusion of the plant in water. Two others still use the juice obtained by extracting the liquid from the plant by maceration/grinding it.
The skins [of pomegranate] I lay in the sun, when dry, I caught it and put it in the plastic bag, tie and keep it, when I need to I get, it is dry [...] it is just crimping . (Romã)
Practices such as bathing and making juice of medicinal plants were in another study18 thus revealing the popular practices, although in this study, as already mentioned, the roasting was the most common practice of the users.
We can see from the speeches, besides the care of wounds with use of medicinal plants, the people of this community, also appealed to the care of modern medicine. It is a complement of care in order to promote the improvement, especially when the wound healing delay or does not produce good results with indications of official medicine.
Because I took what the doctor gave me, Cataflan and I did not get well and the pomegranate heal it. (Aroeira)
Sometimes, it occurs the concomitant use of medicine as with the use of medicinal plants.
First you wash it with hydrogen peroxide then you wipe it, passes a cotton, wipe the wound and then put the powder [powdered pomegranate]. (Romã)
The community is open to use health services, as an ally. What is necessary is interaction between conventional therapy with the popular practice of health care. This association is still incipient, and needs to be encouraged, as well in a study that observed that “the service is still centralized in biological and biomedical models of health and disease, which compromises the recovery of the biopsychosocial needs of individuals results”20:116.
This association is positive for the community, since they diversify care options with the wounds and the local culture is valued, creating economically viable opportunities for disadvantaged sections, as well as promoting the interest and the use of health services2.21.
I use what the doctor gives me because he knows more than me (laughs) He studied and I have nothing! (Carobinha)
Everyone says that has bacteria [...] then we have to use the pharmacy [...]. (Barbatimão)
Assuming a position as a professional taking the person with wound to abandon their ways of care, is first of all allowing beliefs and values to disappear, also dispelling a therapeutic form of care economically available2. Normally people searching to get better spend money, often unnecessary and not always cure them.
[...] I've spent with that leg, I took a lot of medicine, she [CHA] came here and I showed her. I go there, the doctor gave me medicine, I'd spent with a very expensive ointment, and bought and did not improve nothing, nothing! (Jurubeba)
All this reveals the need to consider and combine various forms of care to obtain the greatest possible assurance of therapeutic success and this means also that the professional must ensure that the person has access to therapy, otherwise it will be empty.
Caring for wounds: an empirical and generational learning
When asked about the source of knowledge about the popular practices in the care of wounds, it was possible noticed that the various forms of care adopted by the person attending FHU are cultural practices that permeate a generational knowledge. From the experiences during life the community residents built their own forms of care for their wounds or on the wounds from their loved ones.
Thus, in the statements, we can seen how family traditions influence popular beliefs in care:
It goes from generations, the mastruz [is an example] My mother takes it, uses it, and she makes the juice and put it into the wound. (Mastruz)
This finding is corroborated by a study that also identified how common the transmission of this popular practice of learning from friends, relatives or neighbors, being passed on from generation to generation interconnecting the family culture of several generations18.
Popular practices in the care of the wounds were learning from their mothers, as we see in the statements below:
[...] She (mother) crimped put it on my leg and the it healed. (Romã)
My mother takes it, uses it, and she makes the juice and put it into the wound. (Mastruz)
The mother figure, in particular, is the first source of care, having great importance in the transmission of these popular practices within the family. The injured person believes that the other cares about their pain, leading to an answer of their needs22. It is in the speech of the interviewee:
An old man from the north who taught me [to use potato powder]. He knew I was sick, he lived nearby. He knew and he came to bring it to me, which was very good for the wound. (Jurema)
Commonly, the popular knowledge comes from the transmission of knowledge through the generation, or from the credibility given to the knowledge of the other, being a neighbor, friend or someone known, but sometimes occurs their own trials, which was observed with one of the interviewees, by revealing having used vaginal cream on his wound care, care that originated in their own experiences.
It was all in my head [...] I saw the cream and I thought, my leg hurts I'm going to use it (vaginal cream) there, ready. (Cedro)
These empirical experiences resulting sometimes negative sometimes positive, were in a study in which also one of the interviewees said “I have learned alone, testing the properties of the plants”22:367.
It is necessary to notice, by the health professionals, that the popular practices are still passing to new generations. In this process, they gain new values and meanings, because currently, the options of care increased and health services are increasingly accessible. However the popular care, passed from parents to children, still live within families and communities. We can see it from the interviewee speech:
Pomegranate is good for many things, I have a girl who always has wounds, she has any flu, sore throat that does not improve. Then I do gargle night and morning and give it to her. (Romã)
This confirms that popular practices knowledge are transmitted across generations and reveal the care that is exercised in the family, who continue passing them, with greater interaction and understanding from the health professionals, to learn new knowledge and skills, valuing education, essential to educational practices23.
In this perspective, it is a reflection on the meanings of these practices for the subject, facing the truths established by health professionals24. It is up to the nurse, not fighting it, but to understand their meanings, valuing this knowledge and work experience that takes into account the context of transcultural care7,19,22.
CONCLUSION
From the analysis of categories - Use of popular practices in the care of wounds and Caring for wounds: an empirical and generational learning, it was found that the practices of popular wound care in the community in which the study took place, have their origin in the family crib in learning transmitted across generations and social life. This knowledge represents a significant portion of the local culture. The woman was considered the main promoter of the popular practice of care for wounds, confirming its importance as a first source of expressions of care.
Most of the popular practice of care for the wounds occurred with use of medicinal plants mentioned by the respondents twice from romã, the barbatimão, the cajueiro and jurema, mentioning only once the use of mastruz, mangaba milk, the jurubeba, the cedro, the carobinha, the aroeira and potatoes. These are the most plants used in the treatment of wounds in the community. Among the processes used to prepare roasting, boiling, mashing, obtaining the powder, the water bath and juice in the wound.
It is important the professional to attend to cultural issues in the community, especially the nurse, given its commitment to the care, which can be used not only diagnoses, nursing interventions and outcomes, but a plan of care practices that may cure the pain, making living with the least painful wound and paying attention to the multidimensionality of the client.
Thinking about these clients, it is worth reflecting that the views of professionals are in a different direction to the patients. For the health professional, the wound is something measurable with characteristics emerging a specialized care. On the other hand, for the injured person is something immeasurable, since it is pain, limitations, the way their family and friends see it, it is the cause for search and choice of care.
Although this study was with a small group of users at FHU and in only one municipality, it was possible to reflect the need for greater attention by the nurse in the recovery of popular practices to respect the cultural and generational issues, making the concepts inherent implementing the Transcultural Care Theory proposed by Leininger to systematize nursing care in any setting where care practices developed by nursing staff.
REFERENCES
1. Telles M. Tratamento ambulatorial: particularidades da assistência na rede pública de saúde. In: Silva RCL, Figueiredo NMA, Meirelles IB, Costa MM, Silva CRL organizadores. Feridas: fundamentos e atualizações em enfermagem. São Caetano do Sul (SP): Yendis Editora; 2011. p. 591-600.
2. Di Stasi LC. Plantas Medicinais: verdades e mentiras - o que usuários e os profissionais de saúde precisam saber. São Paulo: UNESP; 2007.
3. Ministério da Saúde (Br). Política Nacional de Práticas Integrativas e Complementares no SUS – PNPIC-SUS. Brasília (DF): Ministério da Saúde; 2006. [citado em 10 jan 2014]. Available at: http://bvsms.saude.gov.br/bvs/publicacoes/pnpic.pdf
4. Kreutz I, Merighi MAB, Gualda DMR. Cuidado popular com feridas: representações e práticas no cuidado na comunidade de São Gonçalo, Mato Grosso, Brasil. Cienc enferm. [Scielo-Scientific Electronic Library Online] 2003 [citado em 23 jan 2014]. 9(1):39-53. Available at: http://www.scielo.cl/pdf/cienf/v9n1/art06.pdf
5. Collière MF. Promover a vida. Tradução de Maria Leonor Braga Abecasis. 2ª ed. Coimbra (Pt): Lidel; 1999.
6. Waldow VR. Cuidar: expressão humanizadora da enfermagem. 2ª ed. Petrópolis (RJ): Vozes; 2007.
7. Leininger MM. Caring an essential human need. Thorofore (NJ): Charles B., Slack Publishing; 1991.
8. Silva DM, Mocelin KR. O cuidado de enfermagem ao cliente portador de feridas sob a ótica do cuidado transcultural. Nursing. 2007; 9: 81-8.
9. Amadigi FR, Gonçalves ER, Fertonani HP, Bertoncini JH, Santos SMA. A antropologia como ferramenta para compreender as práticas de saúde nos diferentes contextos da vida humana. Rev Min Enferm. 2009 [citado em 12 jan 2014]; 13: 139-46. Available at: http://www.enf.ufmg.br/site_novo/modules/mastop_publish/files/files_4c0e47a93ae90.pdf
10. Oliveira, FA. Antropologia nos serviços de saúde: integralidade, cultura e comunicação. Interface (Botucatu) [Scielo-Scientific Electronic Library Online] 2002 [citado em 23 jan 2014]. 6(10):63-74. Available at: http://www.interface.org.br/revista10/artigo2.pdf.
11. Mattos, RA. A integralidade na prática (ou sobre a prática da integralidade). Cad Saúde Pública. [Scielo-Scientific Electronic Library Online] 2004 [citado em 23 jan 2014]; 20: 1411-6. Available at: http://www.scielo.br/pdf/csp/v20n5/37.pdf
12. Soares, JCRS, Camargo Junior KR. A autonomia do paciente no processo terapêutico como valor para a saúde. Interface – Comunic, Saude, Educ. [Scielo-Scientific Electronic Library Online] 2007 [citado em 15 jan 2014]; 11(2):65-78. Available at: http://www.scielo.br/pdf/icse/v11n21/v11n21a07.pdf
13. Araújo EC. Práticas integrativas e complementares em saúde: uso de plantas medicinais no processo de cicatrização de feridas. In: Malagutti W, Kakihara CT organizadores. Curativos, estomias e dermatologia: uma abordagem multiprofissional. São Paulo: Martinari; 2010. p. 163-77.
14. Amaral, JB, Silva MJP. Práticas complementares e os cuidados paliativos. In: Silva RS, Amaral JB, Malagutti W organizadores. Enfermagem em cuidados paliativos: cuidado para uma boa morte. São Paulo: Martinari; 2012. p. 307-34.
15. Salles LF, Kurebayashi LFS, Silva MJP. As práticas complementares e a enfermagem. In: Salles LF, Silva MJP organizadoras. Enfermagem e as práticas complementares em saúde. São Caetano do Sul (SP): Yendis; 2011. p. 1-17.
16. LoBiodo-Wood G, Haber J. Métodos de coleta de dados. In: Pesquisa em Enfermagem: métodos, avaliação crítica e utilização. Tradução de Ivone Evangelista Cabral. Rio de Janeiro: Guanabara Koogan; 2001, p.174-85.
17. Bardin L. Análise de conteúdo. Tradução de Luis Antero Reto e Augusto Pinheiro. Lisboa (Pt): Edições 70; 2007.
18. Siqueira KM, Barbosa MA, Brasil VV, Oliveira LMC, Andraus LM. Crenças populares referentes à saúde: apropriação de saberes socioculturais. Texto contexto-enferm. [Scielo-Scientific Electronic Library Online] 2006 [citado em 16 jan 2014]; 15:68-73. Available at: http://www.scielo.br/pdf/tce/v15n1/a08v15n1.pdf
19. Kruetz I, Gaiva MAM, Azevedo RCS. Determinantes sócio-culturais e históricos das práticas populares de prevenção e cura de doenças de um grupo cultural. Texto contexto-enferm. [Scielo-Scientific Electronic Library Online] 2006 [citado em 23 jan 2014]. 15:89-97. Available at: http://www.scielo.br/pdf/tce/v15n1/a11v15n1.pdf
20. Oliveira MMC, Vieira NFC, Siqueira RC, Alves ÂM, Barroso MGT, Cardoso MVLML. Análise das investigações em enfermagem e o uso da teoria do cuidado cultural. Cienc Cuid Saúde. [Biblioteca Virtual em Saúde] 2009 [citado em 23 jan 2014]. 8: 109-17. Available at: http://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/7784
21. Boehs, AE. Análise dos conceitos de negociação/acomodação da teoria de M. Leininger. Rev Latino-Am Enfermagem. [Scielo-Scientific Electronic Library Online] 2002 [citado em 03 fev 2014]; 10:90-6. Available at: http://www.scielo.br/pdf/rlae/v10n1/7777.pdf
22. Badke MR, Budó MLD, Alvim NAT, Zanetti GD, Heisler EV. Saberes e práticas populares de cuidado em saúde com o uso de plantas medicinais. Texto contexto-enferm. [Scielo-Scientific Electronic Library Online] 2012 [citado em 23 jan 2014]; 21: 363-70. Available at: http://www.scielo.br/pdf/tce/v21n2/a14v21n2.pdf
23. Nunes JM, Oliveira EN, Machado MFAS, Costa PNP, Vieira NFC. Ser mulher e participar de grupo educativo em saúde na comunidade: motivações e expectativas. Rev enferm UERJ. 2014; 22: 123-8.
24. Soares AN, Morgan BS, Santos FBO; Matozinhos FP, Penna CMM. Crenças e práticas de saúde no cotidiano de usuários da rede básica de saúde. Rev enferm UERJ. 2014; 22: 83-8