Qualitative Original Article
there was this coordination between the medical and nursing
teams, we could reduce the time to a week or 15 days before
the operation..." (OR3 P4, February 2022).
The suggestion of "Time/Interdisciplinary Articulation"
highlights the importance of efficient collaboration between
the medical and nursing teams. This suggestion is in line
with the findings of Breda et al.11 and Pires et al.,13 who also
emphasize the need for solid coordination with surgeons
and anaesthesiologists to ensure consistent and safe
information during PNC.
4 – Create visibility
"... Our managers must understand the significance of being
involved as well (...) nurse managers with management
functions, nurse directors, the Board of Directors itself (...)
it is also important to create studies and obtain indicators".
(OR3 P4, February 2022).
The "Create Visibility" suggestion suggests involving
managers and conducting studies to support the importance
of PNC. This call for the creation of studies is supported by
Mendes et al.,4,5,9,10,11,14 who stress the importance of nurses
developing studies that demonstrate the cost-benefit and
efficacy of nursing consultations, providing tangible data to
persuade hierarchies and hospital administration.
According to the data analysis of the participants, most
nurses have innovative ideas, suggestions, and proactive
strategies planned and supported by evidence to achieve
their goals, which include: the implementation of awareness
and training programs for nurses to operationalize the PNC,
and the creation and implementation of quality
improvement projects with the same purpose. It is also
perceived that their prior experience with the PNC
interferes with the results obtained, to the extent that nurses
who work in the OR where the preoperative visit is
performed consider strategies to optimize it, such as
scheduling. Nurses who work in ORs where PNC is not
used, on the other hand, are more concerned with its
prioritization by hierarchical structures, adequate planning,
and operationalization. The study by Pedro et al.14 backs up
these findings.
Some participants argue that it is necessary to foster a spirit
of co-responsibility and collaboration among the hierarchies
at the top and middle of the organizational pyramid. In this
regard, some nurses propose: developing PNC training
based on the most recent evidence; developing indicators
sensitive to nursing care within the scope of the PNC;
developing studies and sharing the results to persuade the
hierarchies, and at the top, the Board of Directors, of the
impact of the PNC subsidies.14
Other studies, though not qualitative, report the following
main difficulties identified by nurses in the implementation
of the PNC: the time available for the procedure, the lack of
human resources, the overlapping of routines in the
inpatient units, the lack of planning, the lack of an
institutional protocol for performing the PNC, the routines
of the OR that decline the possibility of travel to the
inpatient within the working hours, unforeseen changes in
the operative plan, due to the need to adjust operative times,
the secondary priority assigned to the PNC, are some
examples.14 The more visible and recognized the nursing
consultation is in the organizational structure into which it
is inserted, the more successful it will be. To make the
implementation of this consultation easier, several factors
must be considered, including the potential number of
people to be tended, the procedures to be followed, the
human and material resources made available for its
implementation, and the expected time for the PNC to
achieve its goals. These points are supported by Lopes et al.5
and Farrely26, who state that it is possible to know the
production costs, obtain and provide data to the institution,
evaluate qualitative growth, know the costs of treatments
and procedures used, and allocate resources efficiently by
studying these issues. The perception that it is urgent for
nurses to develop studies that demonstrate the cost-benefit
and efficacy of nursing consultations is also supported by
evidence.4,5,9,10,11,14 Regardless of the obstacles that the
operationalization of nursing consultations may face, the
importance of this service justifies the effort required to
implement it, so nurses must make the commitment to work
in this direction.5,14,21
Because it is presented as an inaugural qualitative study in
terms of constraints and nurses' suggestions to the
operationalization of the PNC, the current study adds
scientific knowledge to the evidence. As a result, it is
believed that the findings obtained can be used as quality
improvement indicators.14,22,23
Conclusion
The PNC is a complex process that is influenced by a variety
of factors and has as its basic structure the provision of
nursing care. The findings allow for reflection on nurses'
professional interventions and the identification of potential
areas for change in order to improve clinical nursing practice
and health quality. It is critical to emphasize the role of the
nurse in the PNC in the context of elective surgery. This
professional must have PPS skills in a dimension that allows
them to provide excellent care, supported by evidence-
based practice. It is possible to find contributions that
favour the improvement of care quality and the
optimization of health outcomes in this dynamic between
professional experience and research.
In terms of constraints, participants in this study identify a
number of factors, including a lack of available time,
insufficient human resources, and a lack of appropriate
space, followed by: a lack of agreement on the methodology
to be used – whether in person, the day before, or by
appointment; PPS absent from the service, for the
performance of auxiliary diagnostic tests; delays in the
allocation of beds; privacy compromised at the time of the
PNC; lack of recognition of the PNC by the hierarchical
structures; unpredictable prolongation of intraoperative
activities; distant residence of the PPS.