From leadership research to district action: Theories, models and frameworks of school nursing - a scoping review

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

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. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-025-03730-5.

Study methods

The scoping review was conducted according to JBI Manual for evidence synthesis [23]. It is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist [24] (Additional File 1). The prospectively developed protocol for the scoping review has not been published or pre-registered.

Limitations

A wide variety of models, frameworks and theories for school nursing have been described and important contextual factors regarding the implementation of school nursing were summarised. We did not limit the analysis to countries and analysed the included reports systematically; however, most were developed in the United Kingdom and the United States of America. We did not limit the publication date. Our motivation to include reports over the whole time period was to gather information on how long models have been available. In addition, older theoretical foundations may also offer hints for current school nursing practice or its development. The level of detail between the included reports differs, as the theories and models have different levels and purposes resulting in no in-depth description of individual tasks. However, more structured details would probably lead to an even more concrete overall view. Although the search strategy was developed in consultation with experienced researchers, the absence of a professional information specialist may have reduced the sensitivity of the search. Additional (grey) literature included was searched via reference screening, beyond this no further efforts have been made. The data analysis was conducted by only one researcher. However, the results were discussed with a supervising researcher.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Jana Kaden; Birte Berger-Höger. Theories, models and frameworks of school nursing - a scoping review. BMC Nursing (2025-09-10). https://doi.org/10.1186/s12912-025-03730-5

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.