Consumer-driven co-design of an advanced practice nursing role for older adults undergoing surgery

To establish foundational parameters of a gerontology-informed advanced practice nursing (APN) role to support older adults undergoing surgery, using a multi-phase, evidence-informed co-design process.

This study adopted a participatory co-design approach informed by the Participatory, Evidence-Based, Patient-Focused Process for Advanced Practice Nursing role development (PEPPA) framework. Data were collected sequentially through a scoping review, semi-structured interviews and surveys with older adults and carers, a pre-workshop clinician survey and a multi-stakeholder co-design workshop. Interviews incorporated a Rose-Bud-Thorn reflective activity, and workshop discussions used dot-voting to support shared prioritisation. Qualitative content analysis and descriptive statistics were used to integrate findings across stakeholder groups.

Twelve older adults (including two supported by carers) and 15 clinicians participated across study phases, with 13 attending the co-design workshop. Older adults identified three priority areas for improvement: communication and information needs, coordination and continuity of care and preparation for discharge. Clinicians emphasised frailty-focused assessment, perioperative optimisation, interprofessional coordination and the need for senior APN expertise. Consensus was reached on targeting frail and high-risk surgical patients, adopting a Nurse Practitioner (NP) level for the role and implementing shared governance between perioperative medicine and geriatrics.

The foundational parameters of a gerontology-informed APN role were developed through a rigorous, multi-source co-design process, addressing a critical gap in perioperative care for older adults in Australia. The findings provide a robust evidence base for implementing and evaluating a perioperative APN role that aims to enhance continuity, communication and gerontological support for older adults undergoing surgery.