Integrated cardiopulmonary rehabilitation nursing workforce development: an integrative literature review

The burden of cardiopulmonary disease is increasing, and health systems require a nursing workforce that is prepared to deliver integrated cardiopulmonary rehabilitation across acute, subacute, and rehabilitative settings. However, the educational pathways, competency expectations, and implementation conditions for this workforce remain fragmented. To review and synthesize the literature on workforce development for integrated cardiopulmonary rehabilitation nursing, with a focus on trainee groups, educational strategies, competency development, and implementation implications for workforce preparation in China. An integrative review was conducted because the evidence base on cardiopulmonary rehabilitation nursing workforce development is methodologically heterogeneous and conceptually emergent. Quantitative, qualitative, and practice-oriented educational studies were eligible when they explicitly addressed nursing workforce preparation. A systematic bilingual search was performed in SinoMed, CNKI, Wanfang Data, VIP, Embase, PubMed, CINAHL, the Cochrane Library, and Web of Science, supplemented by reference-list screening and citation tracking. Studies were appraised using the CCAT and synthesized narratively in accordance with integrative review methodology. 9 studies were ultimately reviewed. The included populations comprised specialist nurse trainees, registered nurses, and one student cohort, indicating that the field is currently characterized by a workforce-development continuum rather than a single, fully standardized specialist-nurse pathway. Four major themes were identified: conceptual convergence toward integrated cardiopulmonary rehabilitation nursing; a tiered but non-standardized workforce development pathway; implementation and professionalization are constrained by weak certification and clinical transfer; and context-specific curriculum development remains incomplete, with limited evidence for locally responsive content in China. Five sub themes were retained: recognition of workforce need; fluid trainee eligibility and role entry; multimodal pedagogy with mainly short-term outcomes; broad curricula but implicit competency staging; and inconsistent program duration and weak linkage to expected proficiency. Integrated cardiopulmonary rehabilitation nursing workforce development in China remains at an early stage. Available programs may improve proximal learning outcomes, but evidence remains limited regarding sustained competence, clearly defined clinical roles, and routine service delivery. Future development should establish tiered, competency-based, practice-linked pathways that specify trainee eligibility, curriculum level, and credentialing; combine shared core competencies with cardiac- and pulmonary-specific content and behavior-change support; distinguish local specialist nurse preparation from any future CNS-level role; and incorporate contextually responsive content, including traditional Chinese medicine nursing, only where supported by service needs and competency expectations. Not applicable.