Introduction

Congenital heart diseases are structural and functional abnormalities of the heart, representing the most common congenital anomaly worldwide [1]. As a result of advances in detection, intervention, and long-term management, the survival to adulthood rate has increased to over 95% [2]. Consequently, there are now more adults living with congenital heart disease (ACHD) than children [2]. In Canada, the ACHD population was estimated at approximately 183,840 individuals in 2020, a 68% increase compared to 2007 [3].

ACHD present with unique care needs that differ from the typical adult cardiology population. The ACHD population represents a physiologically distinct cardiovascular group, characterized by structural defects, altered cardiac anatomy, and complex hemodynamic consequences resulting from prior surgical and catheter-based interventions [4–5]. Furthermore, ACHD experience an increased risk of acquired disorders such as heart failure, stroke, coronary artery disease, and atrial fibrillation [6–7]. Despite significant advances in the surgical and medical management of CHD, most interventions are palliative rather than curative [7]. As a result, ACHD often experience long-term cardiovascular complications and progressive disease over decades, necessitating lifelong surveillance and specialized ACHD expertise [7].

Advances in congenital cardiac surgery, interventional cardiology, and diagnostics have markedly improved survival, resulting in a growing and aging population of ACHD [3]. Beyond cardiovascular risk factors, ACHD face a variety of psychological and social challenges, many of which surround the transition into adult care. The transition from pediatric to adult cardiology care is a vulnerable period, with at least 30% of patients experiencing gaps in care or loss to follow-up [2]. During this transitional period, ACHD patients are managing developmental and psychosocial maturation, which can complicate self-management and navigation in the adult healthcare system [2]. Concurrently, ACHD are also undergoing identity formation and shifting social roles, which can contribute to psychological distress affecting transitions in education, employment, and relationships [2]. This is supported by Pelosi et al. [8] longitudinal cohort study, which showed lower educational level, occupational level, and employment rates in ACHD compared to the general population. Finally, the ACHD population also experiences an increased risk of anxiety, depression, and attention problems [2]. A recent meta-analysis [9] further supports the ongoing emotional stressors associated with living with CHD, highlighting the psychological burden of lifelong disease management in this population.

Despite the recognition of the need for specialized ACHD care, nursing education in this area has not evolved at the same pace as medical education [4,10]. Physicians have access to structured postgraduate pathways, such as cardiology residencies and dedicated adult congenital heart disease fellowships, yet no equivalent specialized education exists for nurses [3]. Moreover, pediatric nurses, particularly those working in pediatric cardiac and cardiac intensive care settings, develop specialized expertise in congenital heart disease through unit-based education, clinical exposure, and simulation-based training [11–13]. In contrast, adult cardiovascular nursing education is largely generalist and focused on nursing management of acquired heart disease. This gap in education presents as a critical issue, as nurses provide ongoing care and support to ACHD patients in both inpatient and outpatient settings. This can lead to inconsistencies in the quality of care and missed opportunities for patient education, self-management, and psychosocial support.

Finally, there is existing literature that examines the educational needs and gaps among nurses caring for this population. For example, earlier literature identified systematic gaps in ACHD education, including limited formal education, inadequate resources, and a mismatch between patient needs and workforce preparedness [14]. A cross-sectional study by Griffiths et al. [15] further supports this, as nurses reported low confidence, limited knowledge, and insufficient training in caring for ACHD. However, a preliminary search of the literature did not identify any existing scoping or systematic reviews on this topic. Therefore, identifying existing educational needs for nurses in caring for ACHD is essential to guide future nursing curriculum development and improve care delivery for this growing population.

This scoping review aims to answer the question, “What is the existing evidence on nurses’ educational needs in caring for ACHD?” by identifying and summarizing research and grey literature on the educational needs of nurses who care for this population.

Methods

The scoping review will follow the Joanna Briggs Institute (JBI) methodology [16] and use the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) for reporting the scoping review [17]. The scoping review protocol was developed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P); please see S1 File: PRISMA-P Checklist [18]. This protocol was further informed by Arksey and O’Malley’s [19] five-stage framework for scoping reviews, which includes: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) data charting, and (5) collating, summarizing and reporting the results. The protocol for this scoping review has been registered with the Open Science Framework (https://osf.io/4t5hr) on December 5, 2025.

Step 2: Identify relevant studies

Eligibility criteria.

The inclusion criteria and scope of this review were structured based on the PCC framework [17].

Population.

The review focuses on nurses involved in the care of ACHD. For the purposes of this review, nurses will include regulated nursing designations such as Registered Nurses (RN), Registered Practical Nurses (RPN)/Licensed Practical Nurses (LPN), and Nurse Practitioners (NP), whose practice roles may include advanced practice nurses, clinical nurse specialists, cardiac nurses, congenital/ACHD nurses, and nurse educators with a focus on nurses’ learning needs.

Concept.

The core concept of this review is the educational needs for nursing care of ACHD. Educational needs may include knowledge gaps, skill deficits, competency frameworks, learning needs assessments, training program needs, perceived preparedness, barriers/facilitators to education.

Context.

The context includes caring for ACHD across various healthcare settings. This can include ACHD outpatient clinics, adult cardiology wards, congenital specialty centers, community/primary care, emergency care, intensive care, and transition services when focused on adult care.

Information sources and search strategy.

A health sciences librarian was consulted to create the search strategy, which consisted of a combination of keywords and index terms that focused on the population of ACHD and the concept of interest, which is nursing education. A complete literature search will be conducted using five databases: Medline, Embase, CINAHL, ERIC, and Scopus. The initial search will be conducted in Medline (Table 1). The Medline search strategy will then be translated into the other databases (Embase, CINAHL, ERIC, and Scopus) using the appropriate controlled vocabulary and verified with the health sciences librarian (S2 File). Furthermore, a customized Google Scholar search will be used to search for grey literature, restricting the results to the first 10 pages, and/or until results are no longer relevant [16]. In addition, grey literature sources, such as Grey Matters, and thesis and dissertation databases, will be reviewed to identify relevant literature [16].

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Table 1. Medline search strategy.

https://doi.org/10.1371/journal.pone.0343891.t001

Types of sources.

The scoping review will include all types of published studies with quantitative, qualitative, or mixed-method designs. In addition, non-empirical research, such as grey literature, literature reviews, editorials, and opinion papers, will be included. No geographical, language, or temporal limitations will be set for this scoping review in order to ensure a comprehensive capture of all relevant literature on this topic. If relevant non-English articles are identified, a professional translator proficient in the respective language will be engaged to ensure accurate translation.

Conclusion

This scoping review protocol provides a methodology overview for a scoping review aimed at identifying and summarizing the existing evidence on nurses’ educational needs in caring for ACHD. This information will help inform future research and educational interventions on the nursing care of ACHD.

Supporting information

Acknowledgments

The authors would like to thank Kate Gaffney, Liaison & Education Librarian, at the Gerstein Science Information Centre at the University of Toronto, for their guidance during the development of the search strategy.