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Pensar Enfermagem / v.29 n.01 / Jan-Dec 2025 / DOI: 10.71861/pensarenf.v29i1.430 / e00430

Nursing-led training of school staff to care for children and

adolescents with special health care needs: a scoping review

Mariana Marques1*, Débora Guerreiro2, Ana Bicho3, Sandra Xavier4

1 Escola Superior de Enfermagem de Lisboa, Lisboa, Portugal; orcid.org/0009-0004-3416-2398

2 Escola Superior de Enfermagem de Lisboa, Lisboa, Portugal; orcid.org/0009-0002-8861-4535

3 Unidade Local de Saúde Amadora-Sintra, Unidade de Saúde Pública, Amadora, Lisboa, Portugal; orcid.org/0009-0003-6826-386X

4 Escola Superior de Enfermagem de Lisboa, Lisboa, Portugal; orcid.org/0000-0001-6676-268X

* Corresponding author: mmarques2@campus.esel.pt

Received: 15.03.2025

Accepted: 06.11.2025

Editor: Luís Sousa

How to cite this article: Marques M, Guerreiro D, Bicho A, Xavier S. Nursing-led training of school staff to care for children and adolescents with special

health care needs: a scoping review. Pensar Enf [Internet]. 2025 Jan-Dec; 29(1): e00430. Available from: https://doi.org/10.71861/pensarenf.v29i1.430

Abstract

Introduction

Children and adolescents with special health care needs (SHCN) live with chronic physical and developmental

conditions that affect functioning and require ongoing support from health systems. Nurses work throughout

the lifespan and across various care settings; they are well positioned to provide health education and deliver

specialized care to individuals, groups, and communities, leading to improvements in health outcomes.

Objective

To map the scientific evidence on training school staff to care for children and adolescents with SHCN in

school settings.

Methods

We carried out a scoping review in line with Joanna Briggs Institute (JBI) guidance and the PCC framework

(Participants, Concept, Context). Studies were identified from six international databases between May and

June 2024. Study selection followed the PRISMA-ScR checklist (EQUATOR Network); three independent

reviewers performed the data charting and analysis.

Results

This scoping review included three articles published between 2015 and 2020. Data were charted according to

the main domains of the A-FROM tool. The nursing interventions reported aimed to train school staff through

health education sessions and practice-based activities to build knowledge and competencies.

Conclusion

Nursing-led training for school staff caring for children and adolescents with SHCN showed positive effects

on knowledge regarding the targeted needs, confidence in care, and children’s quality of life. Continued research

and reporting of nursing interventions that train school staff to care for children and adolescents with SHCN

in school settings are essential.

Keywords

Students; School Health Promotion; Nursing; Staff Training.

Introduction

The Alma-Ata Conference in the 1970s was the pioneering conference on primary health care; it addressed

strategies for health promotion and highlighted the relevance of the social determinants of health. Subsequently,

in 1986, the first International Conference on Health Promotion was held in Ottawa. In addition to contributing

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to the goal of Health for All by the year 2000, it responded to growing expectations for a renewal of public

health. It also established a commitment to health promotion, defined as the process of enabling individuals,

groups, and communities to participate and increase control over their health, thereby improving their health

and quality of life.1,2

Portugal has been part of the Schools for Health in Europe (SHE) network since 1994, a World Health

Organization–guided European online platform that brings together schools and organizations to create a

supportive environment for promoting health and well-being among children and adolescents, thereby

improving both health and educational outcomes.3

The National Health Plan 2030 holds that health is a responsibility of society as a whole and that health

promotion applies across all the settings where communities live, work, and learn. A core strategic choice is to

invest in the social determinants of health and well-being by strengthening protective factors, reducing—or

even eliminating—risk factors, and at the same time ensuring the engagement and commitment of all

stakeholders to health outcomes. Accordingly, one specific setting for intervention is schools, as the health of

children and adolescents is influenced by the environments in which they grow, learn, and develop throughout

their school years.4,5

In 2022, Portugal had 1,591,865 students enrolled in preschool; the first, second, and third cycles of basic

education; secondary education; and career and technical education (CTE) programs.6 In the 2021/2022 school

year, the number of non-tertiary educational institutions in Portugal was 8,199.7

All children and adolescents have the right to health and to education. The school community plays a central

role in promoting and maintaining the health and well-being of children and adolescents, given its proximity to

these age groups; it is essential to build local, regional, and national networks, alliances, and partnerships

committed to the school community to address identified needs.4

School health interventions encompass the entire school community—students, school staff, and

parents/guardians—and contribute to improving the quality of the school environment and minimizing health

risks; promoting healthy lifestyles and raising health literacy; and promoting health, preventing disease, and

reducing the impact of health problems on students’ academic performance.4

One of the strategic pillars of the 2015 National School Health Program is capacity-building within the school

community and raising health literacy regarding health conditions, specifically in areas related to special health

care needs (SHCN). School health teams, in coordination with schools and families, are responsible for

identifying, screening, referring, and supporting children or adolescents with SHCN.4

SHCN are defined as “those resulting from health problems that affect functioning and require intervention in

the school setting, such as irregular attendance or the need for special conditions to attend school, and a

negative impact on learning or individual development.”4(p.43) They include chronic diseases, disability,

developmental disorders, and emotional and behavioral disorders, among others.

According to the report Health of Portuguese Adolescents in the Context of the Pandemic, in 2022, 18.6% of

students in Portugal reported a long-term illness, corresponding to 5,809 students. The most frequently

reported diagnosis was allergies, accounting for 49.8% of students with a long-term illness, followed by reduced

visual acuity (35.2%), asthma (27.4%), and mental health conditions (about 10.7%). Additionally, among

students with a long-term illness, 3.8% had heart disease, 2.8% had obesity, 2% had diabetes, and 1.6% had

epilepsy.8

The presence of a long-term illness affects students’ quality of life: 54.5% need to take medication; 29.1% report

effects on participation in leisure activities; 27.2% mention problems with school attendance and participation;

and 12.5% report needing special equipment such as a blood glucose meter, forearm crutches, a wheelchair, or

an adapted computer.8

In addition to the impact on learning, these students require an appropriate response to their SHCN. This

observation underscores the importance of nursing-led training for school staff to care for these students,

providing the school community with initiatives that promote and protect health, build capacity for self-care

and care for others, and prevent disease and disability.4,9

Nurses play an important role in achieving the goals of the National Health Plan and in implementing the

National School Health Program; working in partnership with schools and families, their practice aligns with

these initiatives’ strategic priorities.10

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Nurses are well positioned to promote and maintain health and to build the school community’s capacity to

identify and address its problems from a holistic perspective. They recognize the potential of health education

within nursing interventions and apply the nursing process to strengthen community capacity.10

Accordingly, nurses implement strategies in, with, and for the community—working with partner

organizations—to enable the community to promote health and improve health outcomes. Thus, nursing’s

agenda embraces the following Sustainable Development Goals (SDGs): SDG 3, good health and well-being;

SDG 4, quality education; SDG 10, reduced inequalities; and SDG 17, partnerships for the goals.11

Despite growing recognition of the importance of training school staff in school health, the literature lacks

comprehensive scoping reviews on this topic. A preliminary search in MEDLINE, CINAHL, and Scopus did

not identify recent reviews specifically focused on training across multiple SHCN-related conditions. This

finding underscores the relevance of the present review as a contribution to organizing the evidence and

informing good practices in school settings.

The main objective of this scoping review is to map the available scientific evidence on training school staff to

care for children and adolescents with SHCN in school settings.

Methods

A scoping review is a methodological approach for synthesizing available scientific evidence using a rigorous

and efficient process. The main objectives are to map existing evidence in a research area, identify gaps, and

provide a preliminary exercise that justifies and informs a subsequent systematic review.12

A distinctive feature of scoping review methodology is that it typically does not assess the methodological

quality of included studies, since the aim is to map existing evidence rather than locate the best evidence.12

This review followed JBI methodology and was guided by the question: “Which nursing interventions provide

training for school staff caring for children and adolescents with special health care needs in school settings?”

It was framed using the PCC framework, which organizes the question into three elements: P—Participants

(school staff); C—Concept (nursing-led training for school staff); and C—Context (school settings). This study

adheres to the PRISMA-ScR checklist (EQUATOR Network).12

The protocol for this scoping review is registered on the Open Science Framework and is available at:

https://osf.io/gbcs3.

Eligibility criteria

After formulating the question and defining the objective, inclusion and exclusion criteria were established and

applied to guide the search and subsequent study selection.

Study inclusion criteria:

Participants: school staff, with no restrictions on sex, ethnicity, or personal characteristics

Concept: nursing-led training interventions for caring for children/adolescents with special health care needs

(SHCN). The International Council of Nurses (2001) defines a nursing intervention as “an action carried out

in response to a nursing diagnosis to achieve a nursing outcome,” as cited by the Portuguese Order of

Nurses.13(p15)

Context: the school community, regardless of the educational institution’s geographic location, and whether

the institution is public or private, general or specialized, urban or rural.

Source types: primary studies with quantitative, qualitative, or mixed-methods designs; theoretical articles;

literature reviews; and gray literature—namely dissertations and theses—in English, Spanish, or Portuguese,

regardless of year of publication, with only sources available in full text included.

Exclusion criteria:

Participants: children, adolescents, and families;

Concept: studies addressing special educational needs were excluded. The World Health Organization (2011),

as cited by the Directorate-General for Education and Science Statistics,14(p.?) defines special educational needs

as “a set of significant limitations in one or more domains of life activity and participation resulting from

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permanent functional and structural impairments, leading to ongoing difficulties in communication, learning,

mobility, autonomy, interpersonal relationships, and social participation.”.

Information sources and search strategy

The literature search was carried out between May 18 and June 2, 2024, following JBI’s three-step process for

developing a comprehensive search strategy.12

The first step consisted of identifying the keywords most frequently used in the titles and abstracts of retrieved

papers, as well as the indexing terms used in the literature. To this end, a preliminary search was conducted

using natural-language terms in MEDLINE (via EBSCO) and CINAHL Complete (via EBSCO). The titles and

keywords were analyzed to identify relevant search terms for this scoping review.

Next, a complete and customized search strategy was implemented in MEDLINE (via EBSCO) and CINAHL

Complete (via EBSCO). This strategy was adapted to each database, using natural-language search terms, DeCS

and MeSH indexing terms, and truncations applied to the title, abstract, and MH Exact MeSH Subject Heading

fields. Boolean operators OR and AND were used as detailed in Tables 1 and 2.

Table 1. Search strategy used in the MEDLINE Ultimate database (via EBSCO) on May 21, 2024

Search strategy

Results

TI child* OR AB child*

1,705,663

TI teen* OR AB teen*

36,359

TI school OR AB school

344,820

TI “special needs” OR AB “special needs”

4,809

TI nurs* OR AB nurs*

542,580

S1 OR S2

1,731,003

(S1 OR S2) AND S3 AND S4 AND S5

S7 AND TEXTO INTEGRAL [Filter]

S – search line; * – truncation

Table 2. Search strategy used in the CINAHL Complete database (via EBSCO) on May 21, 2024

Search strategy

Results

TI child* OR AB child* OR MH child*

899,443

TI teen* OR AB teen* OR MH teen*

21,241

TI school OR AB school OR MH school

166,646

TI “special needs” OR AB “special needs” OR MH “special needs”

4,140

TI nurs* OR AB nurs* OR MH nurs*

795,513

S1 OR S2

913,677

(S1 OR S2) AND S3 AND S4 AND S5

S7 AND TEXTO INTEGRAL [Filter]

S – search line; * – truncation

In the second search, all identified keywords and index terms were applied across all included databases,

specifically SCOPUS, JBI EBP Database on Ovid, Cochrane Central Register of Controlled Trials, and SciELO

(Tables 3 to 6).

Table 3. Search strategy used in the SCOPUS database on June 2, 2024

Search strategy

Results

child* (article title, abstract, keywords)

3,956,287

teen* (article title, abstract, keywords)

21,340

school (article title, abstract, keywords)

463,745

“Health care needs” (article title, abstract, keywords)

17,038

nurs* (article title, abstract, keywords)

219,947

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S1 OR S2

1,176,662

(S1 OR S2) AND S3 AND S4 AND S5

S7 AND TEXTO INTEGRAL [Filter]

S – search line; * – truncation

Table 4. Search strategy used in the JBI EBP Database on Ovid on June 2, 2024

Search strategy

Results

child* mp

2,580

teen* mp

163

school mp

1,378

“Health care needs” mp

nurs* mp

7,141

S1 OR S2

2,595

(S1 OR S2) AND S3 AND S4 AND S5

S7 AND TEXTO INTEGRAL [Filter]

S – search line; * – truncation

Table 5 – Search strategy used in the Cochrane Central Register of Controlled Trials database on June 2, 2024

Search strategy

Results

TI child* OR AB child* OR MH child*

196,412

TI teen* OR AB teen* OR MH teen*

3,750

TI school OR AB school OR MH school

12,776

TI “special needs” OR AB “special needs” OR MH “special needs”

314

TI nurs* OR AB nurs* OR MH nurs*

54,232

S1 OR S2

198,926

(S1 OR S2) AND S3 AND S4 AND S5

S7 AND TEXTO INTEGRAL [Filter]

S – search line; * – truncation

Table 6 – Search strategy used in the SciELO database on June 2, 2024

Search strategy

Results

(ab:(necessidades de saúde especiais)) OR (ti:(necessidades de saúde

especiais ))

153

(ti:(escola)) OR (ab:(escola))

9,202

(ti:(crianças)) OR (ab:(crianças))

16,737

(ab:(enfermagem)) OR (ab:(enfermagem))

9,390

S1 AND S2 AND S3 AND S4

S5 AND TEXTO INTEGRAL [Filter]

S – search line; * – truncation

Finally, in the third step, the reference lists of all articles and studies selected for inclusion were reviewed to

identify additional studies potentially relevant for answering the review question.

Selection of sources of evidence

Search results from the different databases were exported, compiled, and managed—first in Zotero 6 for Mac,

then in Rayyan Intelligent Systematic Review to organize and remove duplicate records. Study selection

followed the inclusion and exclusion criteria established for this review. Titles and abstracts were initially

screened, followed by a full-text reading of potentially eligible studies to verify their relevance and suitability

according to the review question. Studies that did not meet the inclusion criteria were excluded. Two reviewers

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independently selected the sources of evidence, and any discrepancies regarding inclusion or exclusion were

resolved by consensus.

Data charting and synthesis of results

To extract relevant information from the studies included in the review, a data charting instrument (table) was

developed in Microsoft Word, based on JBI guidance, to ensure detailed organization and synthesis of relevant

information for each study. These tables contained information on the title, author(s), year of publication,

country of origin, methodology, objectives, population/sample, nursing intervention, and context.12

Results

This section is organized into three subsections: selection of sources of evidence, characteristics of the included

studies, and synthesis of results, each accompanied by summary tables of the analyzed studies.12

Selection of sources of evidence

A total of 110 potentially relevant articles were identified through database searches. Thirteen duplicates were

removed, leaving 97 records. Titles and abstracts of these 97 records were screened; 85 did not meet the

inclusion criteria, and 12 proceeded to full-text review. Of the 12 full-text articles assessed, 10 were excluded:

two did not address the context, four did not involve the target population, and four did not include nursing

interventions. Additional records were identified through citation searching. Of the 123 articles listed in the

reference lists consulted, 20 were selected for full-text review; 17 did not address the review question, and one

was not available in full text. At the end of this process, three articles were included in this scoping review, as

shown in Figure 1.12

Characteristics of the included studies

Three articles published between 2015 and 2020 were included. One study was conducted in New Jersey, United

States, using a literature review design, although the methodology was not explicitly described. The second

study, carried out in California, followed a systematic literature review approach. The third study was conducted

in Egypt and used a quantitative quasi-experimental design.15,16,17

Across all included studies, nursing interventions targeting school staff (teaching and non-teaching) consisted

of training programs aiming at caring for children with SHCN.15,16,17

It was difficult to identify studies in which nursing-led training was directed exclusively to school staff (teachers

and non-teaching personnel). This fact may reflect school settings where a school nurse—employed by the

institution—assumes primary responsibility for caring for students with SHCN as part of routine duties. Among

the reviewed studies, only one specified the children’s age group (preschool), and only one reported the

intervention period, without specifying duration or frequency.15,16,17

The preschool-focused study described nursing-led training for school staff addressing several SHCN-related

conditions in children, specifically asthma, type 1 diabetes, food allergies, and seizures. The remaining studies

involved adolescents with type 1 diabetes (T1D).15,16,17

Synthesis of results

Findings demonstrate nursing-led training designed to develop teachers’ and school staff’s knowledge and skills

for caring for students with SHCN. Tables 7, 8, and 9 present the extracted results and align them with the

review question and objectives.

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Figure 1 – Study selection flow diagram adapted from PRISMA 2020.

Table 7. Data charting from the article “Caring for the youngest students”15

Title

Author(s)

Michelle Lynn

Caring for the

youngest students

Year of publication

2020

Country of origin

New Jersey, United States

Methodology

The literature review methodology was not explicitly described.

Objective

To identify school nurses’ interventions for preschool-aged children with

SHCN.

Population/sample

Staff of preschool institutions caring for children with SHCN

Intervention

Nursing interventions are presented for the following chronic conditions:

asthma, diabetes mellitus, epilepsy, and food allergies. For each condition, the

nursing diagnoses and corresponding nursing interventions are specified.

Interventions directed to teaching and non-teaching staff aim to build capacity

to care for children with SHCN. Core elements of the training include

preventing complications related to these conditions, recognizing signs and

symptoms, and preparing staff to provide a rapid, effective response to

school-based emergencies. Another intervention described is the development

of an Emergency Action Plan (EAP) to be used by school staff in such

situations.

Results

With the implementation of nursing-led training for preschool staff tailored to

each condition and the creation of Emergency Action Plans (EAPs), the

school health team expects outcomes such as the prompt and effective

recognition of signs and symptoms of asthma exacerbations, hypoglycemia,

hyperglycemia, anaphylaxis, and seizures. Subsequently, each staff member

should be able to identify their role and coordinate during emergencies to

prevent more serious problems and achieve improvements in health outcomes

for children with SHCN. Finally, health-promotion actions envisage an

inclusive school in which children with SHCN can participate in the same

activities—or in adaptations appropriate to their health condition—without

adverse impact on their condition.

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Table 8. Data charting from the article “School-based diabetes interventions and their outcomes”16

Title

Author(s)

Peter Schulz e Bénédicte Pansier

School-based

diabetes

interventions and

their outcomes

Year of publication

2015

Country of origin

Switzerland

Methodology

Systematic literature review

Objective

To determine effective school-based interventions to improve health, quality

of life, and academic outcomes in children with diabetes mellitus.

Population/sample

School staff

Intervention

Fifteen primary studies in English (2000–2013) were included. Group 1

(7 studies) focused on educating school staff; Group 2 targeted children with

diabetes to improve health, school performance, and well-being.

Staff-focused interventions were delivered via educational programs,

continuing education, online modules, CD-ROM materials, and the

development of resources for school staff.

Results

Staff-directed interventions were evaluated using quantitative and qualitative

assessments of knowledge gains, satisfaction, and perceived competence and

confidence in caring for children with type 1 diabetes; child outcomes included

quality of life and HbA1c. Designs included pre-/post-assessments and

longitudinal follow-ups. Programs for teachers and non-teaching staff showed

significant improvements in diabetes knowledge following the training (e.g.,

p < 0.033; p < 0.004; p < 0.001).

Table 9. Data charting from the article “Evaluation of the impact of a diabetes education eLearning

program for school personnel on diabetes knowledge, knowledge retention and confidence in caring for

students with diabetes”17

Title

Author(s)

Taha et al.

Evaluation of the

impact of a diabetes

education

eLearning program

for school personnel

on diabetes

knowledge,

knowledge retention

and confidence in

caring for students

with diabetes

Year of publication

2018

Country of origin

Egypt

Methodology

Quantitative quasi-experimental study

Objective

To evaluate the impact of a diabetes eLearning education program—

focused on knowledge and practices for school sta—and to provide a

supportive environment for caring for students with diabetes mellitus.

Population/sample

School health nurses, teachers, and psychologists

Intervention

The intervention comprised three components: knowledge modules, a

skills workshop, and a toolkit with recommendations and resources.

Knowledge content was delivered via an interactive eLearning program.

Eectiveness was assessed using pre- and post-intervention diabetes-

knowledge questionnaires; knowledge and condence were also

evaluated at 6 or 12 months, with half of the sample assessed at 6

months and the other half at 12 months.

Results

A total of 124 public school sta members participated. After the

eLearning intervention, diabetes knowledge increased signicantly

versus baseline (p < 0.0001) on immediate testing and at 6 months [96

participants (77%) retained knowledge] and 12 months [43 participants

(55%) retained knowledge]. At the end of the intervention, the mean

condence score was 61.86% across all seven items assessed in the

questionnaire on caring for children with diabetes mellitus. In addition,

51.1% reported condence in their diabetes knowledge, and 57.4%

reported condence in adequately caring for a child with diabetes

mellitus. Regarding the use of a blood glucose meter, 71.3% reported

condence, and 67% reported condence in treating hypoglycemia.

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Discussion

Summary of the evidence

Nurses’ interventions were valued across all included studies, making relevant contributions to teachers and

other school staff and, consequently, to children with SHCN. The findings of this scoping review identify the

main areas of practice and the nursing interventions delivered in school settings, essentially aligned with training

for school staff who care for children with SHCN.15,16,17

All T1D-focused studies were conducted in schools, and the study encompassing other conditions was carried

out in a preschool institution.16,17,15 According to Lynn, care provided by teaching and non-teaching staff to

preschool children is more demanding than for older children. This article addressed, in addition to training for

T1D management, interventions related to asthma, food allergies, and seizures.15

Regarding asthma, Lynn notes that preschool children have difficulty expressing symptoms during an

exacerbation. Nurses play an active role in training school staff; therefore, nurses need to indicate each student’s

asthma severity and sensitize staff to early manifestations of an attack. The team must recognize signs and

symptoms that require immediate rescue medication.15

Barros identified the greatest health literacy gaps among school staff caring for children with asthma, specifically

in the clinical aspects of the disease, etiopathophysiology, and therapy. After online sessions on triggers,

therapeutic regimen management, and crisis management, delivered within a training project for preschool and

early-elementary caregivers, there was a significant increase in knowledge among teachers and non-teaching

staff (p < 0.001), demonstrating the program’s effectiveness.18 The Directorate-General of Health states that

training for asthma should focus on acquiring knowledge about the disease process, signs and symptoms, early

recognition of exacerbations, adherence to pharmacologic treatment, and skills for correct use and adherence

to controller therapy, such as inhaled therapy.19

For food allergies, in addition to the asthma-like challenge that preschool children may be unable to verbalize

symptoms of an anaphylactic reaction, the same author notes that preschoolers often explore the classroom

environment and may inadvertently ingest food residues there. Hence, the relevance of nursing-led training for

school staff to identify signs and symptoms of anaphylaxis. In the event of an anaphylactic crisis, all staff should

have the knowledge and skills acquired through health-education actions, an Emergency Action Plan, and the

immediate administration of the indicated therapy (epinephrine), required for this situation.15

Regarding seizures, the emphasis again is on nursing-led training for staff in preschool settings, with a focus on

primary prevention. To complement training, the nursing team should train staff in first aid and provide the

skills needed to manage seizure emergencies.15

All studies included in this review mention nursing interventions that build the capacity of school staff to care

for children with T1D, both in preschool settings and across other school ages.15,16,17

No differences were observed in the types of nursing interventions for preschoolers versus older students with

T1D. The interventions aimed to improve health, quality of life, and academic outcomes by training school

staff through multiple formats, including in-person and online educational programs. Statistically significant

improvements were observed in knowledge and skills, in participants’ perceived confidence to care for children

with T1D, and in children’s quality of life after the interventions.16

Similar findings—significant increases in diabetes knowledge and confidence in caring for children with T1D

—were reported by Taha et al. following an eLearning program complemented by hands-on sessions.

Gonçalves implemented three health-education sessions for teachers and two for non-teaching staff, achieving

the impact indicators and demonstrating higher knowledge levels; the educational content across the three cited

studies was comparable.17,20

However, Taha et al. was the only study to include longer-term follow-up (6 and 12 months), showing positive

knowledge retention related to T1D. Lynn described the training content for preschool educators, but did not

report outcomes or impact.17,15

By contrast, Belourico reported improvements in knowledge, confidence, and quality of life among preschool

children with T1D after delivering one online health-education session and one in-person practical session to

preschool teachers and classroom assistants. These sessions included opportunities to handle and simulate

insulin and glucagon administration techniques, as well as capillary blood glucose monitoring.

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SHCN have numerous physical, emotional, and socioeconomic impacts, placing a substantial burden on

children and their communities. To ensure adequate management of SHCN, school staff should be engaged in

promoting health and students’ quality of life. Accordingly, across the studies, health promotion, health

education, and training for school staff caring for children with SHCN were prioritized to support self-

management and reduce costs, exacerbations, hospital admissions, and absenteeism from school and work.18

The data synthesized in this review underscore the strategic role of nurses in promoting health in school

settings. For practice, there is a need for ongoing educational programs for school staff. At the policy level,

capacity-building within school systems should structurally integrate nurses into school contexts. For research,

gaps remain in longitudinal, multicenter, and experimental studies that evaluate the effectiveness and

sustainability of these interventions over the long term.

Conclusion

This scoping review aimed to analyze and map nursing interventions in school settings that train school staff

to care for children and adolescents with SHCN. Three studies were included, differing in implementation type

and duration. All studies trained teaching and non-teaching staff who care for children and adolescents with

SHCN, and one extended the interventions to psychologists and school nurses.

Addressing these gaps will require primary, experimental, and longer-duration studies with larger samples and

broader geographic coverage. In addition, research should examine outcome selection and long-term evaluation

methods to refine and improve school-based interventions. The studies included here, together with subsequent

investigations, can inform health and school policies that improve health outcomes.

Study limitations

This review included only articles published in English, Portuguese, and Spanish. Including articles in other

languages could strengthen the review. Conducting a methodological appraisal of the included studies would

also be relevant, although it is not required in scoping review methodology.

Authorship and Contributions

MM: Contextualization, methodology, software, writing (original draft), writing (analysis and interpretation),

first independent reviewer, final approval of manuscript, assumption of responsibility.

GD: Software, writing (analysis and interpretation of data), second independent reviewer, approval of final

version of manuscript, assumption of responsibility.

BA: Validation, writing (analysis and editing), third independent reviewer, critical review, approval of the final

version of the manuscript, assumption of responsibility.

XS: Validation, critical review, approval of the final version of the manuscript, assumption of responsibility.

Conflicts of interest and Funding

No conflicts of interest were declared by the authors.

Sources of support / Financing

The study was not funded.

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