Care strategies for children with tracheostomy at school: a scoping review

Pessanha, Fernanda Borges; Depianti, Jéssica Renata Bastos; Pimentel, Thaís Guilherme Pereira Pinheiro; Cabral, Ivone Evangelista

doi:10.1590/1980-220X-REEUSP-2025-0096en

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REVIEW • Rev. esc. enferm. USP 59 • 2025 • https://doi.org/10.1590/1980-220X-REEUSP-2025-0096en linkcopy

Care strategies for children with tracheostomy at school: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective To map care strategies for children with tracheostomies in school settings.

Method A scoping review was conducted following the JBI® methodology. A comprehensive search strategy was employed across health, education, and gray literature databases in July 2024. The included studies described guidelines, care policies, and the experiences of family members, healthcare professionals, and education professionals regarding the care of children (6–12 years old) with tracheostomies who regularly attend school.

Results The 30 texts retrieved that met the eligibility criteria identified three models of school healthcare: family-based, health-education intersectoral, and school health outpatient-based.

Conclusion The successful inclusion of children with tracheostomies in educational settings necessitates intersectoral health-education coordination in the development of guidelines. Review protocol registered at https://osf.io/3tcg4.

DESCRIPTORS
Child Health; Tracheostomy; Mainstreaming; Education; School Nursing; School Health Services

Source of information

Search strategy on July 24, 2024

PubMed

((Tracheostomy[mh] OR Tracheostom*[tiab]) AND (“Infant”[mh] OR infant*[tiab] OR Child[mh] OR child*[tiab] OR Children[tiab] OR “Disabled Children”[tiab] OR “Children with Disabilities”[tiab] OR “Children with Disability”[tiab] OR “Disabled Child”[tiab] OR “Handicapped Children”[tiab] OR children special health care need*[tiab] OR “exceptional child”[tiab] OR “exceptional children”[tiab] OR “technology dependent child”[tiab] OR “technology dependent children”[tiab] OR “Special Needs Child”[tiab] OR “Special Needs Children”[tiab])) AND (“Mainstreaming, Education”[mh] OR Education Mainstreaming[tiab] OR Educational Mainstreaming[tiab] OR “Return to School”[mh] OR Return School*[tiab] OR “School Health Services”[mh] OR “School Health Services”[tiab] OR “School Based Health Services”[tiab] OR “School Based Services”[tiab] OR “School Health Promotion”[tiab] OR “School Health Service”[tiab] OR “School Based Health Service”[tiab] OR “School Based Health Services”[tiab] OR “School Based Service”[tiab] OR “School Based Services”[tiab] OR Middle School Teacher*[tiab] OR Elementary School Teacher*[tiab] OR “educational institution”[tiab] OR “school building”[tiab] OR “school organisation”[tiab] OR “school organization”[tiab] OR School*[tiab] OR “Elementary Education”[tiab] OR “Elementary School”[tiab] OR “Middle Schools”[tiab] OR “Primary Education”[tiab] OR “Secondary Education”[tiab] OR “intermediate school”[tiab] OR “junior high school”[tiab] OR “junior secondary school”[tiab] OR “lower secondary school”[tiab] OR “Schools”[mh] OR Primary School* OR Secondary School*[tiab] OR “Schools, Nursery”[mh] OR Nursery School*[tiab] OR “Students”[mh] OR Student*[tiab] OR “Education, Special”[mh] OR Special Education*[tiab] OR “Education”[mh] OR Education[tiab] OR Educational Activit*[tiab] OR Literacy Program*[tiab] OR “Teaching”[majr] OR Teaching[tiab] OR Educational[tiab] OR “Schools, Nursing”[mh] OR Nursing School*[tiab] OR Nurse Training School*[tiab] OR school aged[tiab])

Author, year	Country	Study nature/design	Population/setting	Study objective
Mahomva et al.(⁴²) 2017	South Africa	Qualitative	Four mothers, two fathers; four teachers/Home and school	Recommendations for schools to become safe and accessible for CWT.
Kruger et al.(¹⁶) 2009	USA	Qualitative	13 nurses/School	Considerations Regarding the Challenges and Advantages of Collaboration Among Nurses, Parents, and Staff in Pediatric Care Settings
Casey(¹⁷) 2002	USA	Qualitative	18 school nurses/School	School nurse responsibilities for medically fragile students.
Mukherjee et al.(⁹) 2000	England	Qualitative	58 family members, 34 teachers/School	Challenges Faced by Educators in Providing Care for Children.
Rehm and Rohr(¹⁸) 2002	USA	Qualitative	11 family members, nine nurses, eight teachers, five school nurses/Home, classroom, nursing office	The measures implemented by families, educators, and healthcare professionals to promote and safeguard the health and safety of children within educational environments.
Shimizu and Katsuda(¹⁰) 2015	Japan	Qualitative	11 teachers/School	Educators’ Perspectives on the Responsibilities of School Nurses in Caring for Technology-Dependent Children.
Shimizu and Suzuki(⁴¹) 2015	Japan	Qualitative	21 nurses/School, classrooms, care room	The role of nurses caring for technology-dependent children in schools.
Esperat et al.(¹⁹) 1999	USA	Mixed method	618 teachers, 43 school nurses/School	The need for education and healthcare services in the care of CWT in schools.
American Academy Pediatrics: Committee on Injury and Poison Prevention(²⁰) 2001	USA	Practice guidelines report	NA	Procedures guideline for CWT during transport.
Graff and Ault(²¹) 1993	USA	Practice guidelines	NA	Guidelines for staff supporting students with special healthcare needs.
Grundfast et al.(⁸) 1988	USA	Medical center model program	NA	Integration of CWT into the school system.
Haynie et al.(²²) 1989	USA	Care guidelines	NA	Guidelines and useful information for transforming technological advances and social commitment for children.
Janz et al.(²³) 1993	USA	Care guidelines	NA	Discussion of the issues of including CSHCN in the regular classroom.
Lehr and Greene(²⁴) 2002	USA	Practice guidelines	NA	Considerations, challenges, and procedures for supporting students with complex healthcare needs in educational settings.
Lehr(²⁵) 1990	USA	Practice guidelines	NA	Educational programs for students with complex healthcare needs.
Levine(²⁶) 1996	USA	Case study	Four male students and two female students/School	Ventilator-dependent students’ experiences.
Makrinioti et al.(³⁹) 2021	England	Editorial	NA	A multidisciplinary strategy for CWT’s school reintegration challenges
Margolis(²⁷) 2002	USA	Legislation and policies	NA	Using school healthcare services laws and policies.
Palfrey et al.(²⁸) 1992	USA	Consultative school model	NA	Skills training planning and procedures.
Parette et al.(²⁹) 1994	USA	Inclusion model	NA	Role of pediatric nurses.
Porter et al.(³⁰) 2013	USA	Emergency preparedness	NA	Emergency care guidelines for students at school.
Raymond(³¹) 2009	USA	Case study	6-year-old boy/School	Integration process, team roles, and implications for school nursing practice.
Smith and Leatherby(³²) 1992	USA	Guidelines	NA	Delivering special healthcare procedures to students at school.
Toothaker and Cook(³³) 2018	USA	Non-systematic review	NA	School nurse skills for caring for students with CWT.
Mulligan-Ault et al.(³⁴) 1988	USA	Quantitative	150 teachers/School	The role of school nurses.
Patel et al.(³⁵) 2009	USA	Mixed method	23 children/Hospital	CWT’s school experience.
Pufpaff et al.(³⁶) 2015	USA	Quantitative	76 school nurses/School	Collaboration between school nurse and teacher.
Smith et al.(⁴⁰) 2003	United Kingdom	Quantitative	11 family members and the child’s caregiver at school/Hospital	Identification of children attending school and the support they receive.
Heller et al.(³⁷) 2000	USA	Quantitative	342 teachers, 49 non-nursing healthcare professionals, 21 nurses, ten school administrators	Health skills training for non-medical staff to ensure safety.
Sapien and Allen(³⁸) 2001	USA	Quantitative	230 school nurses/School	Readying public schools for new health requirements per guidelines.

Topics covered in training	Healthcare professional(³⁷,³⁸)(n = 572)			Family member and non-professional caregiver(n = 643)
Topics covered in training	School health nursing professional (n = 1,078)	Physician (n = 88)	Rehabilitation professionals (n = 132)	Healthcare service (n = 159)	Family member (n = 444)	Caregiver (teacher + mediator) (n = 199)
First aid(³⁷)		256		–	–	–
Cardiopulmonary resuscitation(³⁷,³⁸)		526		–	–	–
Aspiration(³⁷) n = 559	283	24	38	48	113	53
General tracheostomy care(³⁷) n = 539	272	17	30	49	128	43
Inhaler/nebulizer use(³⁷) n = 516	250	23	23	28	127	65
Oxygen administration(³⁷) n = 486	273	24	41	34	76	38

Variables	N (384)	%
Trained education professionals
School teaching team	150	39
Formal program	76	20
Informal	64	17
With the family	54	14
In a program developed by a university	40	10
Sources of information on childcare needs and demands	N (247)	%
Family	83	34
Family physician	58	23
School health nurse	58	23
Rehabilitation professionals	48	20

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] USA – United States of America. NA – not applicable; CWT – children with tracheostomy; CSHCN – children with special healthcare needs. Source: prepared by the authors.