Applying Person-Centered Care Model in the Postoperative Period of Renal Transplant Recipients: A Comprehensive Nursing Approach

Abstract

This study delves into the vital role of education in caring for kidney transplant recipients, underscoring the imperative for personalized, patient-centered educational programs. The analysis of nursing care quality standards, concerning health promotion, complication prevention, and autonomy, highlights the critical relevance of education in post-transplant management. Educational strategies, including participatory models and interdisciplinary approaches in the teaching process, are discussed. The conclusion underscores the nurse’s pivotal role in comprehensively understanding the patient and effectively promoting resocialization after transplantation.

1. Introduction

Renal transplantation is considered the treatment of choice for end-stage renal disease (ESRD) [1]. Acknowledging its significance in ESRD treatment and its impact on the lives of those undergoing this intervention, we pose the question of the nurse’s pivotal role in this field. The first query that arises is as follows: to what extent does this transformative process initiated by renal transplantation, introducing subsequent metamorphoses, qualitative ruptures, or any other notable discontinuities in the lives of kidney recipients, pose challenges, opportunities, and/or difficulties for nurses caring for these individuals in this critical period? The second inquiry seems to warrant phrasing in the following manner: what is the nurse’s role in the success of renal transplantation, considering the risks and complications that the surgery entails? Before outlining, in broad terms, the response to these two questions, we allow ourselves to make the following observation: in this reflection on the nurse’s role and the resources at their disposal to adequately address it, we are always part of a team of healthcare professionals contributing their expertise to achieve the intended outcome, namely, the effective functioning of the renal graft. In this regard, and already beginning to address the first question posed, Murphy [2] draws attention to the complexity, challenges, and rewards of nursing care for this population. The author delves into various activities within the nurse’s competence defined in the nursing process. Starting with the assessment of the transplant recipient, we refer to its impact on gathering essential data for constructing an individualized care plan. Indeed, from the implementation of the nursing process in the postoperative period, the nurse works in multiple directions through specific guidelines, identifying problems, formulating diagnoses, defining expected outcomes and associated interventions, and assessing health gains for the person under their care [3, 4].

So, to start with one end of the issue, the care process begins with the patient’s admission to the transplant unit after receiving a phone call from the hospital informing them that a kidney is available for them. Through precise instructions, the nurse responsible for the patient provides them with an overview of the scenario that awaits them in this period preceding the surgery. This information is rich in specifics about preoperative routines, extending to various spheres that constitute preoperative care: physical and psychological care, with special attention to the emotional and sociocultural spheres. Assessment is a relevant component as it encompasses the clinical, psychological, social, cultural, and economic history of the individual. The collection of these elements allows the nurse to easily describe the profile of the person in front of them, namely, assess functional capacity, describe the morphology of the support network, understand social status, habits, and lifestyles, the affective component, and know the services they use (community, health system, formal, and informal). Studies show that the success of kidney transplantation is directly related to the individual’s health status and support network. This detailed assessment provides the foundation for formulating personalized care plans, centered on the individual needs and peculiarities of each recipient.

Some essential elements of the preoperative period underlying patient safety involve establishing a patient safety culture, defined as the set of best practices shared by healthcare professionals to prevent risks or harm to the patient in the pre, intra, and postoperative periods. This involves the adoption of protocols.

The postoperative period requires the implementation of preventive measures, early identification of potential complications, and patient education promotion. All these points are particularly relevant when considering the crucial role that the understanding and adherence of the transplant recipient assume in the success of kidney transplantation beyond the surgical act itself. From these elements emerges the care for the emotional state in response to the fears and anxieties of the transplant recipient facing the unknown world that has now begun. This attentive look acts as an effective device that guarantees the person’s safety and protection in the face of present insecurity.

During this critical time, the nurse helps the person prepare to return home with tranquility and safety, which means adopting a patient and family-focused model.

The focus on the postoperative period goes beyond the necessary physical care for hemodynamic stability and the physical recovery of the transplant recipient. The answer to the second question is reflected in the paradigm shift and the investment in a new person-centered care model. If we observe its composition, we find that it aggregates physical/biological and psychosocial aspects, giving us a holistic and integrative view. The answer we have just outlined manifests, on the one hand, the structural axis of healthcare, which we could formalize around the dichotomies of person/health professionals, continuity/discontinuity, as the person, from our point of view, is the center of healthcare. Presently, the care system insists on the primacy of the person; its action is aimed at the individual and implicitly or explicitly asserts its primacy.

2. Person-centered care model for renal transplant recipients

The extent and significance of the person-centered care model vary across sociocultural contexts. In Europe, there is an appreciation for the person-centered care model, transcending the traditional healthcare approach by placing the individual at the core of care. This care model is more than a methodology; it is a philosophy that recognizes the unique attributes, preferences, and aspirations of each healthcare consumer. In the context of renal transplantation, the complexity and uniqueness of each individual highlight that person-centered care emerges as a guiding principle capable of meeting their physical, psychological, social, and cultural needs [5, 6].

One underlying reason for this choice is that, while the surgical act is crucial for the success of the transplant, the nurse’s work represents a significant framework in the recovery of the transplant recipient. Infection prevention interventions, complication management, and health education promotion, including training in the management of immunosuppressive medication, also ensure the success of the surgery. Preparing the transplant recipient with the necessary adjustments for adaptation to the new reality mobilizes the material and emotional resources needed to live with the new organ. It also ensures the functions of protection, support, and assistance in transitioning back to family, professional, and social life in a new setting.

Available information indicates significant advancements in surgical techniques and immunosuppressive therapy, with renal transplantation being by far the most commonly performed surgical procedure in clinical practice [7].

All organ transplants are regulated by law. In Portugal, Law No. 12/93 of April 22 establishes the conditions related to the harvesting of organs and tissues of human origin. Its application extends to all Portuguese citizens, stateless individuals, and foreigners residing in Portugal [8].

The transplant can come from a living or deceased donor, and in Portugal, all citizens are considered potential post-mortem donors unless they express a contrary wish and are registered in the National Non-Donor Registry (RENNDA) [9].

According to data from the Portuguese Institute of Blood and Transplantation, in 2022, 495 kidney transplants were performed in Portugal. Observation of the records shows an increase in the overall donation rate between 2021 and 2022 (451 versus 495), similarly occurring in the first half of 2023 when compared with the corresponding period (223 versus 285) [10, 11, 12].

It is commonly accepted by authors that renal transplantation is the treatment of choice for end-stage renal disease in terms of survival and quality of life [13, 14, 15, 16].

The success of renal transplantation needs to be viewed through the perspectives of different actors with diverse knowledge, concentrating and reinforcing their efforts in caring for the renal transplant recipient. Success will depend on the ability of these professionals to prepare the transplant recipient for adaptation and harmonious integration into the new context for an active life with the new organ. Questions about success arise positively. For example, how can this specific group and their families cope with the situation? How do we maximize the success of the renal graft? With which actors? Through what practices?

With the implementation of person-centered care, the aim is to generalize healthcare practices that respect the values and preferences of patients and promote their autonomy. Providing information, communicating, and educating are three essential aspects of this process. It is intended, from this care model, that the starting point be the needs and problems felt by individuals, their involvement in the therapeutic process, and in partnership with different healthcare professionals, facilitate healthy adjustment, culminating in the success of renal transplantation.

All of this leads to the consideration of actors as fundamental agents in the process, but above all, to imperatives of participation, interdisciplinary participation, and participation with the patient and family, and it is in this context that nurses play a central role in promoting and adapting the transplant recipient, helping to alleviate uncertainty and strengthen self-efficacy [16].

The transition from the surgical process to the post-transplant phase is marked by the beginning of a complex and challenging journey fraught with uncertainty, fear, and change. The role of the nurse gains prominence in promoting recovery and ensuring a healthy transition to the new reality of the renal transplant recipient.

Each interaction, each care provided, is permeated by an understanding of the unique goals, preferences, and challenges of renal transplantation. Taking person-centered nursing care as a reference, let us explore how these specific nursing interventions contribute to the success of renal transplantation in preventing risks and complications associated with surgery.

2.1 The person-centered care model

2.1.1 Definition and principles of person-centered care

The person-centered care model (PCCM) places the individual at the forefront of their care process and focuses on three main aspects: safety, education, and communication [17]. The concept itself takes on different terms to express similar principles and activities, such as holistic care, personalized care, among others [18]. Here, we understand the concept from the perspective of a holistic approach that considers the person in various dimensions: biological, psychological, social, and cultural.

In the context of renal transplantation, beyond the physical component associated with the surgical act, the psychological, social, and cultural components play a significant role in the individual’s recovery and transition to the new reality. It all begins with empowering the person, giving them an active role, making it important to consider an individual-centered care model. Informed decision-making and support in disease self-management can improve the quality of care and health outcomes [18]. It is essential to understand the role of nurses in promoting care centered on the needs of the individual, based on their biological, psychological, and sociocultural needs. What is their degree of intervention, not only in interventions defined by nurses but also in the type of interventions they consider most suitable for the individual?

According to the Health Foundation, collaboration between the patient and healthcare professionals involves exploring what matters to the person and identifying the best treatment, care, and support. Thus, involving the person leads to better outcomes than “individual” decisions made by healthcare professionals. The nurse’s support as a help system cannot be overlooked. Numerous factors, each playing a specific role, influence the care chain developed during the care process [18].

After renal transplantation, individuals face various challenges: physical, emotional, and social, need to deal with an increasing number of aspects related to transplantation, such as medication regimen, lifestyle changes, complications, infections, and adjustment to a new reality [19].

In short, there is intense turbulence caused by the new conditions. New resources, skills, and competencies are required to cope with the situation. At this moment, there is a crucial awareness of the need to rebalance life, which can only be achieved in its entirety by involving all individuals directly involved: the transplant recipient, family, and healthcare professionals. Such a strategy will only be viable through a person-focused care approach, aiming for the individual to develop the knowledge, skills, and abilities to make informed decisions and manage their therapeutic regimen [15].

The immediate question is: In the post-surgery period, what nursing interventions have been developed to care for the renal transplant recipient?

The part of nursing that addresses these issues falls under the competencies of nurses specializing in nephrology. According to the Portuguese Order of Nurses, nurses specializing in medical-surgical nursing (EEEMC) in the area of chronic disease are qualified to care for individuals with end-stage renal disease (ESRD) undergoing renal transplantation. The regulation proposed by the College of the Specialty of Medical-Surgical Nursing, approved in 2018, defines the specific competency profile of EEEMC, in addition to the common competencies of the nurse specialist defined in regulation n° 429/2018. The specific competencies include:

1. Caring for individuals/families/caregivers experiencing chronic illness, applying the nursing process, and developing specialized interventions.

2. Maximizing the therapeutic environment in collaboration with individuals/families/caregivers experiencing chronic illness [20].

The first point emphasizes partnership, safety, and quality of care, involving the identification of the needs of the individual and the family experiencing, in this particular case, a complex surgical process.

The second important point involves the prevention of complications and, in a broader approach, understanding the complexity of the situation experienced. The evaluation of the impact of surgery on the quality of life and well-being of the transplant recipient and their family is an area of intervention for the specialist nurse.

The activities developed in the next phase of the process aim to prepare the renal transplant recipient for the transition. Therefore, support for the transplant recipient and their family is crucial for obtaining favorable health outcomes. The post-transplant period is challenging in that the individual moves toward a new path fraught with uncertainties and potential complications [21].

Cooperation between the transplant recipient, their family, and the nurse brings benefits when a commitment is made to undertake the best strategies for promoting, preventing, and managing the disease. It is hoped that the individual gains skills through learning experiences promoted by the nurse, develop abilities for managing the new condition, and can find solutions to detected problems. Thus, the appreciation of the potential of the individual and their family is positive and adds value to the therapeutic relationship.

In this regard, and to give an idea of the relevance of the specialist nurse in caring for the renal transplant recipient and their family, we highlight two key aspects of their responsibility: the safety of the patient and the quality of nursing care, which, although transversal to all nurses, have greater weight for the specialist nurse and are part of their competencies, as can be consulted in the regulation of specific competencies of the EEEMC in the area of chronic disease. This includes preventing complications and adverse events resulting from the disease, managing the therapeutic environment, promoting a safe and quality environment in the provision of nursing care, and preventing and controlling infections, both within the healthcare team and by assisting the patient and their family in adhering to infection prevention and control behaviors [22].

On the agenda, the issue that gains visibility in the field of renal transplantation is the quality of life of renal transplant recipients, involving the incorporation of knowledge about the disease (a circumstance that, according to some authors, may be at the root of a disturbing beginning due to the unfamiliarity of how to deal with the new situation) and how to manage it.

After transplantation, the individual remains hospitalized for an average of five to ten days before being discharged home [23]. During this hospitalization period, various events can occur, such as post-surgery complications, for example, deep vein thrombosis, paralytic ileus, bleeding, renal artery thrombosis, urinary fistula, lymphocele, infection, pain, and rejection, among others [24].

The rate of major complications after transplant surgery is low and has a very small contribution to graft loss, but it requires the attention of the nurse [25]. A rigorous assessment of the patient is essential to prevent and/or minimize complications. Thus, considering the need to ensure the safety of the individual, promote effective recovery, prevent complications, and facilitate the transition to an active life with the new organ, specific nursing interventions are needed. This leads us to the following question: what care do nurses promote in the postoperative period for the renal transplant recipient?

In the next section, we answer this question.

3. Applying person-centered care in the postoperative phase

3.1 Postoperative care nursing interventions

The context of nursing interventions during the postoperative and recovery period involves various essential actions. By explicitly focusing on the contribution of nurses in this scenario, we cannot overlook other critical elements, especially in the context of renal transplantation. A fundamental aspect is preparing the individual for the return home, aligning with the principles of the ontology of nursing care. In this context, there is an opportunity to develop a holistic approach that considers the individual as a whole, addressing physical, emotional, social, and spiritual aspects.

The integration of health education in this context emerges as the essential link to empower transplant recipients to live fully with the new organ. Focusing on preparing for the return home and adopting a holistic approach establishes the bridge of health education as a strategic element of a cognitive process aimed at empowering the individual for self-management of their condition, providing them with extensive knowledge about living with the renal graft. This allows the individual to be the subject of their own journey.

Health education, as a tool for teaching and learning, gives mastery to the patient and enables them to become autonomous subjects capable of making informed decisions. Indeed, a crucial aspect of education is aligned with the individual’s individual needs, recognizing them as an active and capable entity. Thus, health education not only informs but also empowers, aligning with the holistic and person-centered vision that guides the entire care process in the field of transplantation.

The generated debate, markedly directed toward the recovery period and the preparation of the renal transplant individual for the return to normality, not only highlights their role as the main actor in this process but also emphasizes optimizing the success of transplantation through education, however, without intending to relegate the crucial relevance of the biological aspect in postoperative care.

According to the literature, the implementation of the Enhanced Recovery After Surgery (ERAS) protocol in the preoperative, intraoperative, and postoperative periods promotes patient recovery, reduces the risk of complications, facilitates early discharge, and reduces healthcare costs [26].

Studies indicate that the implementation of ERAS is well-established in various surgical areas but is a relatively new concept in renal transplantation [27, 28, 29, 30]. However, its application in renal transplantation has shown benefits for the patient. In a study by Dias et al., the authors developed and implemented the standardized ERAS protocol in 200 transplanted patients, of which 100 were subjected to the protocol and the other 100 to standard care. The study took place between 2017 and 2018, and the outcomes of interest were the length of hospital stay, the incidence of delayed graft dysfunction, and the readmission rate. The results showed, in the experimental group, a shorter average length of hospital stay than the control group by 2 days (the average length of hospital stay in the experimental group was 5 days and in the control group was 7 days), and for 79% of participants in the experimental group, discharge occurred on the fourth postoperative day. The rate of delayed renal function was similar in both groups, as was the readmission rate. For the authors, the implementation of the ERAS protocol, in addition to being essential, is safe since there was no increase in the complication rate and/or delayed renal graft function [31].

Another study allowed us to verify the benefits of ERAS in renal transplantation. The authors included 286 renal transplant recipients, of which 135 underwent the recovery program, and 156 received standard care. The study’s objective was the application of ERAS principles and measuring changes in quality of life and satisfaction with care. The results showed a lower use of morphine for postoperative pain management in the experimental group compared to the control group and statistically significant (median was 9.5 vs. 47 mg; P > 0.001). Similar to the previous study, the authors also obtained a shorter average length of hospital stay in the experimental group than in the control group (median was 5 days vs. 7 days; P < .001). Unlike the study by Dias et al., the authors found in the experimental group a readmission rate of less than 5% in the 10 days following transplantation [32].

If the above-described view of the benefits of the ERAS protocol in renal transplantation seems like a path to follow, based on research confirmed in the literature, this new approach, albeit recent in the field of renal transplantation, is highly stimulating if we think about the challenge of responding, through models and strategies, to the uncertainties, fears, concerns, and needs of renal transplant individuals.

The principles underlying this approach are those of a person-centered approach, so they can be easily adapted to renal transplantation. A multidisciplinary team consisting of surgeons, anesthesiologists, intensivists, nephrologists, nurses, and other healthcare areas involved in care for renal transplant individuals, such as a nutritionist, radiologist, pharmacist, social worker, etc., is involved in the entire process. The transplant recipient is involved in this process [33].

The program encompasses three stages: stage 1, the period preceding surgery; stage 2, the period immediately before surgery; stage 3, the immediate recovery period corresponding to the period of preparing the individual for discharge, that is, helping the individual leave the hospital as soon as possible if well prepared and ensuring support at home after hospital discharge [34].

This is an evidence-informed approach aimed at minimizing the stress caused by surgery and helping the individual recover quickly. However, its implementation remains challenging and should be adapted to each patient [35].

This framework, already theorized in various disciplinary fields, should be problematized in the context of renal transplantation as a reference framework for caring for renal transplant individuals.

The ERAS approach includes three domains, as mentioned earlier: preoperative, intraoperative, and postoperative. Since our focus is on the postoperative period, the recommended actions for this phase encompass many nursing interventions developed by the nurse during this period, such as:

• Rigorous monitoring, through constant monitoring of vital signs.

• Monitoring renal function with special attention to diuresis. Significant changes may indicate graft dysfunction or rejection. Monitoring laboratory values ​​such as creatinine and urea.

• Pain control and multimodal analgesia.

• Early mobilization. Prevention of deep vein thrombosis and pulmonary embolism. This may also involve the administration of low molecular weight heparin, if prescribed by the medical team.

• Adequate hydration and nutrition. On the first day after surgery, initiate a liquid diet, progressively evolving to a solid diet according to tolerance.

• Control of nausea and vomiting.

• Complications. After a transplant, patients face a myriad of potential postoperative complications. These include surgical complications such as wound infections, bleeding, or organ damage, as well as the risk of viral, bacterial, and fungal infections due to the immunosuppressive medications required to prevent organ rejection. Additionally, there’s a constant concern for graft dysfunction and organ rejection, which can manifest as a decline in organ function or outright rejection by the recipient’s immune system. Moreover, patients may also encounter other complications such as neoplasms and cardiovascular issues, further emphasizing the importance of vigilant post-transplant care and monitoring.

• Infection prevention. Removal of medical devices (urinary catheter, drains) as soon as the clinical condition allows (on average, they remain for 5 to 7 days). Surveillance of the surgical site, implementation of infection prevention and control measures such as hand hygiene.

• Immunosuppression.

• Emotional support.

• Promotion of autonomy.

• Patient education [36].

This set of actions corresponds to the quality standards of nursing care (PQCE) defined by the Order of Nurses, namely health promotion, prevention of complications, well-being and self-care, and functional readjustment. A study conducted in Brazil analyzed postoperative care for kidney transplant recipients based on the perception of 10 nurses. According to the participants, the interventions in their clinical practice for this group include monitoring vital parameters, infection prevention with particular attention to hand hygiene, hydration, diuresis monitoring (Fluid Balance), immunosuppressive medication, pain control, and monitoring complications. Anxiety is also a central focus of their care. The discharge plan is not part of their routine [37].

However, the hospital discharge plan is a fundamental element in preparing the individual for home and is essential in promoting autonomy. Standardized discharge plans contribute to increasing self-care capacity, communication between the nurse and the patient, and preventing hospital readmission. Post-transplantation requires the individual to manage their disease concerning symptom management, medication, complications, and infections. This fact leads us to consider health education as a key factor in promoting self-care in disease management [38].

In reality, the need to respond quickly to the situation created by the transplant challenge highlights education as a fundamental component in preparing the individual for home. During hospitalization, the transplant recipient and their family learn how to care for their renal graft. Building on the PQCE defined by the Order of Nurses, the nurse helps the individual achieve the maximum health potential. Thus, in line with the goals set with the individual, particularly regarding self-care, the nurse creates and seizes opportunities to promote identified healthy lifestyles. Additionally, they provide information that promotes cognitive learning and the development of new capabilities by the individual [22].

The promotion of autonomy involves preparing the patient and their family, as mentioned earlier, and education is a valuable tool from the perspective of requirements for hospital discharge. A review study on nursing care in the postoperative period of renal transplantation highlights education as an important factor in the success of renal transplantation [39].

The relationship between self-care and health outcomes is close. The educational process directed at the transplant recipient and their family regarding self-care behaviors is essential for effective management of their health condition. It is due to this need that education is considered the cornerstone in caring for this specific group [24].

After transplantation, individuals need to learn to manage a complex medication regimen, monitor the side effects of therapy, monitor signs of rejection and infection, and deal with complications and comorbidities [40].

Investing in education is understood as a means to equip the individual with the essential tools for self-management. Support also plays a significant role in this learning process [41]. What education strategies can be developed in the transplant scenario to prepare for the return home?

In the next section, we address education as one of the pathways to transplant success.

4. Patient education for self-care

In the normal sequence of actions to ensure the success of surgery and the quality of life for transplant recipients, several authors have outlined education programs aimed at kidney transplantation. The choice of participatory education models takes into account the degree of importance attributed to individuals in managing their illness process. This scenario includes a randomized clinical trial conducted in 2018 in Tabriz, Iran, involving 60 hospitalized kidney transplant recipients at the Iman Reza Hospital. The authors implemented and evaluated the effectiveness of a self-care education program for this population.

The study aimed to develop and implement an education program based on the needs of this specific group to assist them in resolving emerging problems and improving their quality of life. Initially, researchers administered a questionnaire to participants to identify their needs. Subsequently, they developed the education program, consulting a nephrologist beforehand. Education sessions were conducted at the patient’s bedside and lasted for 30 to 45 minutes. Three sessions were provided to the experimental group. Researchers used a book as a resource for the education session, covering concepts and definitions of the disease, medication, dietary regimen, physical exercise, and self-care activities. The results showed statistically significant differences between the two groups after administering the education program, particularly in self-care and quality of life. In the domain of self-care education, the experimental group had, on average, higher scores than the control group after the educational sessions (average scores in self-care and quality of life between the two groups: EG = 6.017 vs. CG = 5.175; p > .001). They concluded that the education program is effective in improving knowledge about kidney transplantation and quality of life. They emphasize the role of nurses in promoting the knowledge and skills necessary for disease management [42].

Several studies emphasize the nurse’s role in preparing transplant recipients for their new condition. Training should be seen as a means of support for change, and in this perspective, nurses play a fundamental role [2, 13].

Some studies clearly demonstrate that education should be tailored to the individual’s background to promote successful learning, with the teach-back model proving crucial for ensuring learning success [43, 44, 45].

Interdisciplinarity is fundamental in the educational process, contributing to the education of transplant recipients. Nowadays, it is challenging for transplant education to be confined to a single discipline due to various constraints related to knowledge development, technological advancement, and the individual needs of the person. The nurse’s assumption of this role does not imply that other healthcare professionals are entirely excluded from this process. Nurses are with patients 24 hours a day, providing them with more time to understand their physical and psychological needs, including motivation and readiness to learn [2].

The involvement of the patient remains undeniably crucial, especially when they will be responsible for managing their health condition. Changes after transplantation will undoubtedly influence what is learned, how it is learned, and even the stereotypes constructed about the disease. Some studies suggest that many patients struggle with managing their illness because they are unaware of the relevance of their participation in the process and how to handle the complexity associated with the situation. One of the nurse’s functions is to inform the person about the challenges and complications that the situation brings. Transplant recipients need to acquire knowledge about immunosuppressive medication, monitor signs of rejection, and understand the benefits of changing certain lifestyle styles [46].

Urstad and colleagues [47] demonstrate in their study the effect of an educational intervention on the knowledge, adherence, self-efficacy, and quality of life of kidney transplant recipients. They conducted a randomized clinical study involving 139 participants, with 77 in the experimental group and 82 in the control group. Various measurement instruments were applied (knowledge questionnaire, SF-12, self-efficacy scale, and observation). Measurements took place between the 7th and 8th weeks post-transplant.

Statistically significant differences were found between the two groups in terms of knowledge in both assessment periods (p = 0.002 and p = 0.004). Similarly, self-efficacy scores differed between the two groups in both assessments, with the experimental group showing higher values than the control group (p = 0.036), and the quality of life followed the same direction (p = 0.001). The authors concluded that a personalized education program tailored to the individual positively influences knowledge, self-efficacy, and quality of life.

This leads us to the following question: what to include in the education program? Based on the literature, we have defined some contents that we consider relevant for the teaching/learning process, namely:

1. Personalized and Individualized Education

   • Consider specific characteristics of the individual, such as health literacy levels, particularly regarding kidney transplantation, cultural preferences, and medical history.

2. Competency-Based Education

   • Focus on the competencies necessary for self-care, enabling the acquisition of skills/capabilities needed to manage their condition.

3. Incorporation of Technology

   • Incorporate innovative technologies, such as mobile applications or online platforms, to facilitate real-time access to information. They can serve as a means of continuous support and easy access to educational resources.

4. Involvement of the Family

   • Involving the family in the educational process, besides providing emotional support, plays an active role in helping the person adhere to recommendations.

5. Proactive Approach to Potential Complications

   • Include information on warning signs of possible post-transplant complications and teach proactive management of any abnormal symptoms that may arise.

6. Continuous Assessment of the Individual’s Understanding

   • Continuous assessments should be conducted to identify any cognitive changes that may compromise the ability to learn and manage the disease.

In our view, education sessions should address immunosuppressive medication, self-care (monitoring renal function, urinary output, blood pressure, temperature, weight, and capillary blood glucose if clinically indicated, surveillance for signs of rejection and potential infections), healthy lifestyles, vaccination, and sexuality.

Another important aspect is the establishment of personalized goals, effective communication, follow-up, and continuous support.

The transition to kidney transplantation requires an adaptation period that necessitates communication, a teaching pace tailored to each individual’s rhythm, the encouragement of a strong dynamic with spaces for dialog, a space to respect and integrate cultural differences, and also different personalities.

It is essential to give space for transplant recipients and their families to participate in the project, starting by listening to their priorities and expectations, trying to understand their logics, and then preparing them for any challenges that the disease may bring.

5. Conclusion

What can be concluded?

The nurse caring for kidney transplant recipients faces daily challenges that cannot be ignored. Therefore, for the success of kidney transplantation, it is important to develop a comprehensive understanding of transplantation and the lives of those being cared for: who they are, how they live, with whom they live, what their concerns, worries, beliefs, expectations, religion, and cultural context are. Knowing each of these facets in their interactions with the individual and their family helps to obtain a holistic view of the whole that characterizes them and develop personalized/individualized education programs.

Education is an important factor in teaching/learning and should follow a standardized, person-centered structure. In fact, individuals with chronic kidney disease need to reintegrate into society once transplanted, and most are on an equal footing in terms of knowledge and disease self-management skills. Success lies in adherence to the therapeutic regimen in its various aspects. Studies show that the better-adapted group is the one that learns to cope with the disease and experiences fewer difficulties.

In this context, the nurse’s role is crucial to overcoming difficulties and providing transplant recipients with the necessary tools for a healthy adaptation. Education should be considered an essential and never secondary element because, as we have seen, it is through education that better openness to socializing with kidney transplantation is achieved, and the self-efficacy and autonomy of the transplant recipient are built.

Conflict of interest

The authors declare no conflict of interest.