**1. Introduction**

A closer look at health education programmes shows a panoply of studies focusing on this issue and their influence on citizens' skills and abilities by giving them the tools for learning, taking into consideration their personal needs and problems.

Over time, perspectives and approaches have changed as health systems have evolved. The ageing population and the increase in chronic diseases have put health services under enormous pressure and generated the need to rethink supply in relation to demand. In the context of economic and social modernisation, which has led to an increase in the well-being of one and all, we have seen infectious diseases

under control, the infant mortality rate quite low and the death rate diminished. In this vision, resplendent with a better future, life expectancy increased significantly and with it, the proportion of elderly people in the population increased. This accelerated process of economic, social and health changes has considerably improved the living conditions and quality of life of the populations. We are therefore witnessing an increase in chronic diseases, many of which are the cause of high morbidity and mortality [1].

Many of these chronic diseases require long-term care, which contributes to increased healthcare expenditure. Associated with these issues are the high disability rates that affect the living conditions of this group of people.

The dividends of the growth of the elderly population and the conquests in the field of health have allowed the profound transformation of the condition of the population in general and the elderly group in particular. The State maintains support to eliminate social insecurity and ensure the population's conditions of subsistence in economic, social and health care terms [2].

Despite the complexity of this point, people are living longer with chronic diseases and disabilities and health systems are facing budgets under increasing pressure, so societies have sought solutions in order to guarantee the accessibility of their citizens to health care and, at the same time, the survival of health systems. Patient-centred care is thought to be the way forward. As a coordinated care process tailored to people's needs, it supports the development of people's knowledge, skills and confidence to manage their health in an informed way, i.e., the process promotes the means for self-care practice [3].

Now, more and more health systems advocate the path of patient empowerment and involvement, although there are divergences between countries on this issue, and the path of patient dependence on health professionals has not yet been fully abandoned. The issue is also related to rising healthcare costs due to the longevity of the population and the rising prices of drugs and technology, with the system at risk of collapse if the pre-existing models of care are maintained [4].

For Coulter & Magee, the collapse can be avoided if patient autonomy and involvement are encouraged. The emphasis on patient autonomy encourages citizens to adopt healthy lifestyles and consequently puts less pressure on health systems [5].

This idea takes us to the heart of the debate about moving healthcare from doing 'for' people to 'with' people, including them in decisions and making them accountable for their health. As part of this shift towards patient-centred care, health professionals need to focus on educating patients, their conditions and treatment options, and inviting them to participate and be involved in their health care.

The interest in health education results from the articulation of all these elements, longevity of the population that conditions a higher prevalence of chronic diseases, often disabling, related to lifestyles.

Thus, logic of the need to empower people to learn to take care of themselves throughout their lives underlies the process. The Declaration of Alma-Ata itself, resulting from the conference held by the World Health Organisation, underlines that 'People have the right and the duty to participate, individually and collectively, in the planning and execution of health care' ([6], p. 92).

In this declaration, health education is inscribed as the first priority for promoting tools to improve the health conditions of populations and meet their needs.

What happens is that, as seen previously, not all countries show changes in the way they provide care, still maintaining the characteristics of the past, despite the efforts to dialogically involve the patient in decision-making processes [4].

### *The Dialogue between the Patient's Educational Needs and the Knowledge Transmitted by Nurses… DOI: http://dx.doi.org/10.5772/intechopen.103891*

As we know, one of the goals of patient-centred care is to integrate the patient as a partner in healthcare. The success of this partnership depends on professionals taking patients' preferences into account. It is necessary to understand the philosophy of 'patient-centred care'. Can one have patient-centred care while excluding the patient from the process? These are two antinomic terms that cannot coexist simultaneously. The idea is to understand patients' preferences and support them in making decisions that meet those preferences [7].

As patient-centred care is a participatory process, which recognises the role of patients and their ability to assess and determine their needs, the voice of the professionals is not expected to be the privileged element for decisions on treatment/health care.

The reference to education, carried out in health facilities, aims to establish collaboration between the health team and patients in order to increase their effectiveness in relation to their needs and to support them in mobilising knowledge and skills in favour of disease management.

A brief historical review observes different trajectories related to the context of each era, which marked the way in which health systems developed healthcare.

In the 1960s and 1970s, the doctor was the authority, and the patient was a passive person, from whom no active participation in decision-making on healthrelated issues was expected. The process had as its structuring element a logic of domination/submission in which it was the professional who decided, without taking into account the patient's wishes and preferences, the latter conforming to the former's decisions [8].

Medical power prevailed as the dominant power, medical knowledge as central knowledge and patient knowledge as lay knowledge [9].

In response to the medical-centric model, various movements advocating the rights and interests of patients were set up, thus becoming a driving force for the defence of patients in their most diverse expressions. In the face of such movements, a new development process began from which the contours for a model transition were outlined, medical intervention has been extended to other spheres of social life and health professionals are no longer the only people involved in treating patients [10].

In the 1980s, patient education goes further by focusing on the totality of the patient's interests and the completeness of the patient's values. Several factors converged for this to happen, like the emergence of chronic diseases, the paradigm shift from the biomedical model to the holistic model in health care, the influence of ethics in health care, patients' dissatisfaction with health care, and the call for more information and participation in decisions related to their health [11].

At a political level, macro-trends were registered in the emerging model of people's information and education, the right of access to information, participation, and quality of health care, through systemic and contingent interaction in the face of the change of rethinking health care and the involvement of people who are consumers of health care. In this framework, a new ingredient is added, embodied in the application of technology to education programmes. Thus, education programmes have to be rethought and health organisations have to become organisations that listen to the future, using what can be called holistic teaching-learning systems [12].

In the 1990s, this trend continued, the paternalistic model was abandoned, and the patient became responsible for decisions regarding his/her health. The new logic led to a displacement of the central spaces of professional/patient interaction from the macrosocial, led by the health organisations, to the microsocial space, i.e., to the patient's home, because the patient's life takes place mostly outside the spaces of the

health organisations, with daily behavioural self-regulation becoming of indisputable importance in the treatment results. Thus, a model for teaching and training selfregulation behaviours based on a dialogue of equals between health professionals and patients was established [13].

In addition to the patient's involvement, the participation of their wider social network, such as spouse, children, friends, etc., should also be considered. Another relevant factor at this stage is the Internet, which has become a common space and source of information for patients.

The twenty first century, in the field of health, is characterised not only by the increase in chronic diseases but also by multiple comorbidities that complicate treatment and health costs. With this scenario in mind, a global collective project is considered important in health education, which implies the constitution of expressive solidarities between health systems and citizens, in order to act on a large scale and allow the development of integrated education programmes. Going back to Delors when he said that education, and in this particular case health education, is the treasure or the entrance to the twenty first century, it is considered that education is an essential dimension for well-being and for the development of all the person's capabilities [14].

The World Health Organisation's definition of health had already introduced these aspects by extending the concept to the psychological and social dimension of the individual in addition to the biological dimension [15].

It is for this reason that the holistic model is recognised and valued by all. Thus, it is necessary to consider the person and their needs and establish with them the actions that allow them to acquire knowledge and skills to change behaviours, with a view to a healthier lifestyle [16].

The first problem that arises is to determine whether there is currently a change of perspective and attitudes on the part of health systems/health professionals regarding patient education.

It is clear that the main figure in health education is the patient, it seems unequivocal that without autonomy there is no learning. It is important to remember that the person is the protagonist of his/her life project, the active agent of his/her educational process and state of health. Consequently, a relationship is established between illness and lifestyles in addition to other factors such as gender, family structure, environment, and socio-economic conditions [17].

The second question relates to the nature of the health education programmes promoted by nurses to kidney transplant patients. The hypothesis considered is the following: the programmes organised to inform the dialysis patient about waiting list, and to empower them about transplant process, those mobilised around other issues such as daily life management, medication, complications, rejection, and quality of life [18–24].

The object, scope and practices regarding the teaching-learning process change according to the stage the patient is at, i.e., whether the focus is on the pre-transplant or post-transplant period.

Our starting point is post-transplantation. The aim is to analyse in-depth the various education programmes developed in this field of knowledge, identifying their most visible aspects and characteristics. It is, above all, a panoramic survey of the most striking aspects of education programmes in the field of post-transplantation.

Self-determination, motivation, and free choice are important concepts in patient education. The person assumes an active role in this process, through the choices they make, and their accountability for the decisions made. In other words, he/she is free to *The Dialogue between the Patient's Educational Needs and the Knowledge Transmitted by Nurses… DOI: http://dx.doi.org/10.5772/intechopen.103891*

decide from a range of possible choices. Health professionals involved in this process should bear these aspects in mind because they are extremely important. They should identify the difficulties and constraints that the person faces on a daily basis and promote the means and tools to overcome them [25, 26].

The subjectivity, personal experience, situational, social, economic, cultural, temporal and spatial-geographic factors of the patients are also aspects to be considered by health professionals due to their influence on the teaching-learning process [27].

Health education implies the recognition and identification of the person's symbolic frames, which help professionals to understand their decisions and alert them to the need to anticipate consequences that could be disastrous for them.

In this context, we propose to make an incursion to the studies carried out in this field and dissect the key points of the various education programmes. It seems important to identify the various models and education programmes aimed at transplanted renal patients, not only to verify the differences and similarities but also to disseminate the information already produced towards the transformation of practices.

Underlining the relevance of health education in patient empowerment and self-efficacy, it is essential to define the concept, explore the education programmes implemented in the area of post-renal transplantation and identify their contributions to patient learning.

Before advancing with the proposed objectives, another aim was added: to highlight the nurses' role in this process. Having said this, we now move on to the next section.
