Theories, models and frameworks of school nursing - a scoping review.

Background: School nursing is a complex clinical specialty practice that varies across different countries. Theories, models and frameworks can inform nursing practice. This scoping review aims to explore the conceptualisation and operationalisation of school nursing in theories, models and frameworks.

Methods: A scoping review was conducted according to the JBI Manual for evidence synthesis. To identify existing theories, models, frameworks and concepts of school nursing, we searched in the databases Medline/PsycInfo, CINAHL and ERIC from earliest date until 08 March 2024. There was no limitation regarding the study type, school settings and countries. For data analysis, theory and concept analysis was employed, supplemented by content analysis with additional type building. School nurses' tasks were clustered according to the WHO guideline on school health services.

Results: We identified two theories, eleven different models, and seven different frameworks that were reported in 28 publications. Both identified theories aim to empower school nurses, and provide orientation. Among the identified models and frameworks, we identified three types, which were "Role and practice models/frameworks", "Organisation and delivery models/frameworks" and "Qualification models/frameworks". Definitions and aims of school nursing varied in the identified literature. Aims included improving or supporting student health, health care access, education and school attendance. Further frameworks aim to strengthen the role of a school nurses or to promote their professional development. Tasks of school nurses comprise health promotion, health education, clinical assessment and preventive interventions. Leadership, evaluation and coordination were identified as key elements of school nursing, associated with autonomy. Most of the theoretical foundations describe a Bachelor's degree as minimum qualification for school nurses.

Conclusion: The identified theoretical foundations are intended to support school nurses in developing their role, tasks and structure in relation to the targeted aims. School nurses' complex role profiles require appropriate competencies that go beyond a qualification on a Bachelor's degree level. The results could inform practice implementation, development and further research by reflecting and evaluating the existing practice. For countries without widespread implementation of school nursing, the identified theoretical foundations could serve as a base for further implementation steps.