Competences and skills of nurses in school health: a scoping review

Dantas, Hallana Laisa de Lima; Lima, Ana Beatriz de Almeida; Mendes, Ryanne Carolynne Marques Gomes; Linhares, Francisca Márcia Pereira; Sette, Gabriela Cunha Schechtman; Vasconcelos, Eliane Maria Ribeiro de

doi:10.1590/1983-1447.2025.20240034.en

ABSTRACT

Objective: to map scientific evidence on the professional competences and skills of nurses who work in school health.

Method: Scoping review based on the manual from the protocol for writing Evidence Syntheses from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - extension for Scoping Reviews. The search was conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature; Latin American and Caribbean Literature in Health Sciences; Medical Literature Analysis and Retrieval System Online; SCOPUS; Web of Science; Science Direct; Educational Resources Information Center; Embase; Google Scholar.

Results: Twenty studies were selected, none of them Brazilian. The scientific evidence was organized into four thematic axes: promotion, prevention, assistance, and health education. There was a shortcoming as the role of nurses in schools was not well understood, with routines and regulations that vary according to the sociocultural aspects of each territory. The most mentioned skills were communication, management and leadership.

Conclusion: The nursing competences and skills mapped proved to be internationally diverse, however, studies are recommended that investigate the practices of nurses working in the context of Brazilian student health public policies and a better delimitation of the concept of school nursing.

Descriptors:
School Health Services; School Nursing Services; Health Promotion; Professional Competence

RESUMO

Objetivo: mapear as evidências científicas sobre as competências e habilidades profissionais de enfermeiros que atuam na saúde escolar.

Método: Revisão de escopo a partir do protocolo do Manual para Síntese de Evidências do Joanna Briggs Institute e redação orientada pelo Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A busca foi realizada nas bases de dados: Cumulative Index to Nursing and Allied Health Literature; Literatura Latino Americana e do Caribe em Ciências da Saúde; Medical Literature Analysis and Retrieval System Online; SCOPUS; Web of Science; Science Direct; Educational Resources information Center; Embase; Google Scholar.

Resultados: Foram selecionados 20 estudos, nenhum deles de origem brasileira. As evidências científicas organizaram-se em quatro eixos temáticos: promoção, prevenção, assistência e educação em saúde. Verificou-se uma fragilidade na compreensão da função do enfermeiro na escola, com rotinas e regulamentações que variam de acordo com os aspectos socioculturais de cada território. As competências mais referidas foram comunicação, gerência e liderança.

Conclusão: As competências e habilidades em enfermagem mapeadas se mostraram diversificadas internacionalmente, no entanto, recomenda-se estudos que investiguem as práticas dos enfermeiros atuantes no contexto das políticas públicas de saúde estudantis brasileiras e uma melhor delimitação do conceito enfermagem escolar.

Descritores:
Serviços de Saúde Escolar; Serviços de Enfermagem Escolar; Promoção da Saúde Competência Profissional

RESUMEN

Objetivo: mapear la evidencia científica sobre las competencias y habilidades profesionales de los enfermeros que actúan en salud escolar.

Método: Revisión del alcance basada en el protocolo del Manual de Síntesis de Evidencia del Instituto Joanna Briggs y redacción guiada por los Preferred Reporting Items for Systematic reviews and Meta-Analyses - extension for Scoping Reviews. La búsqueda se realizó en las siguientes bases de datos: Cumulative Index to Nursing and Allied Health Literature; Literatura Latinoamericana y Caribeña en Ciencias de la Salud; Sistema de recuperación y análisis de literatura médica en línea; ESCOPUS; Web de la Ciencia; Ciencia directa; Centro de información de Recursos Educativos; Embase; Google Académico.

Resultados: Se seleccionaron 20 estudios, ninguno brasileño. La evidencia científica se organizó en cuatro ejes temáticos: promoción, prevención, asistencia y educación para la salud. Hubo debilidad en la comprensión del papel del enfermero en las escuelas, con rutinas y normativas que varían según los aspectos socioculturales de cada territorio. Las habilidades más mencionadas fueron comunicación, gestión y liderazgo.

Conclusión: Las competencias y habilidades de enfermería mapeadas resultaron ser diversas a nivel internacional; sin embargo, se recomiendan estudios que investiguen las prácticas de los enfermeros que actúan en el contexto de las políticas públicas de salud estudiantil brasileñas y una mejor delimitación del concepto de enfermería escolar.

Descriptores:
Servicios de Salud Escolar; Servicios de Enfermería Escolar; Promoción de la Salud; Competencia Profesional

INTRODUCTION

School is an environment conducive to the development of children and adolescents. It must be prepared to provide them with adequate cognitive, affective, and psychomotor stimuli. School nursing attempts to monitor this process, which is a social determinant of health, by promoting, preventing, and providing health education to the community as a whole¹.

The concept of school nursing dates back to late nineteenth century, with the pioneering work of Lina Rogers Struthers, who was the first school nurse in the United States and implemented school programs in New York schools. Her work showed how important it is to integrate health and education, laying the foundations for the development of school nursing as a specialized practice².

In many countries, school nursing is a branch of nursing work that specializes in recognizing, screening, and anticipating the care needs of individuals with a certain profile³. To achieve a proficient performance, the professional must find support in theoretical and practical knowledge capable of producing effective results, compatible with the health goals of children and adolescents¹.

However, despite being recognized in many countries as a specialty in the care and promotion of the health of children and adolescents at school, it is not officially regulated as a specialty in Brazil as of yet, being most often a complementary activity carried out in other public health contexts². Nevertheless, this initiative is especially significant in areas where access to health services is limited³.

In Brazil, the term "school nurse" has historical roots that relate to the first decades of the twentieth century, when school nursing was associated to the control of infectious diseases in schools, in a period in which sanitary conditions were poor and health education started to be integrated in the curricula².

In 2007, presidential decree n. 6.286 transformed the Health at School Program (PSE, in the original acronym) into a public policy⁴. It was targeted at the intersectoral activity that articulates health and education to deal with vulnerabilities that threaten the development of Brazilian schools and the formation of their citizens⁵.

Health actions predicted in the context of PSE consider multiprofessional competences related to care, promotion, prevention, and assistance, and are simultaneously developed by the public and basic health networks, and are coherent with the principles and directives of the Single Health System (SUS)⁵^,⁶.

These actions involve health evaluations of the students (clinical, ophthalmological, oral, auditory, and psychosocial); updating and control of the vaccine calendar; actions to prevent against the use of drugs; decreased alcohol consumption; reduced morbidity and mortality due to accidents and violence; and controlling smoking and other cancer risk factors. Furthermore, actions are conducted to promote sexual and reproductive health, healthy eating, exercise, and a culture of peace, in addition to permanent education in health and the inclusion of health education topics in the Pedagogical and Political Projects (PPP) of schools⁶.

In this context, the nurse frequently assumes the role of educator, caretaker, and agent of school health promotion, leading activities such as lectures, professional training, contests, and health events in the context of different settings⁷. However, to implement school nursing practices is to deal with substantial challenges. Chief among them is the growing privatization of primary health care services in Brazil, which requires high productivity from nursing workers, often to the detriment of health promotion actions that could go beyond said units⁸.

Additionally, the high turnover of these professionals compromises the continuity and quality of intersectoral actions proposed in public health policies, weakening the bond between health workers and the school community. In many places, Community Health Agents (CHA) are the ones responsible for these actions, which may limit the reach and efficacy of school health interventions⁴.

Despite the complexity and importance of this health policy, there are perceptible weaknesses in its operationalization. This is due to the lack of specific and consistent knowledge regarding how and what to do in the school setting. Furthermore, in many countries, intersectoral actions are fragmented, not well articulated and episodic⁷.

Due to the scarcity of studies discussing and indicating aspects that gather different realities, successful experiences, and profitable strategies for school health in nursing practice, it is essential to take advantage of opportunities to consider possible solutions and advancements that can contribute to produce a more effective articulation between health and education, which, in turn, can help reach the 3rd and 4th goals of sustainable development⁸, related to health and wellbeing and quality education.

Understanding this gap is socially relevant, as it directly interferes with the quality of care and support provided to children and youth in school environments - and, therefore, to family and society. It is interesting to have more clarity regarding the competences and skills necessary to the permanent education of school nurses, in order to guide and enhance school assistance public policies.

Therefore, this study aims to map the scientific evidence on the professional competences and skills of school health nurses.

METHOD

Study design

This is a scoping review, that is, a study whose goal is tracking information about a concept, setting, or specific condition. To describe this research, we used the extension for scoping reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist (PRISMA-ScR)⁹, in the scope of the Manual for the Synthesis of Evidence of the Joanna Briggs Institute¹⁰. A register was created in the Open Science Framework (https://osf.io/ahru9/)¹¹.

Research Question, Search, and Inclusion Criteria

The research question was created using the "PCC" mnemonic tool, where "P" stands for "Population", "C" for "Concept", and "C" for "Context", generating the question: What are the characteristics of the professional competences and skills of nurses working in School Health Services? It is noteworthy that the PCC helped formulating the search strategy through the use of the Descriptors in Health Sciences (DeCS) and the Medical Subject Headings (MeSH) (Chart 1).

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Chart 1 -
Organization of the descriptors used in the search strategy - Recife, PE, Brazil, 2023.

Inclusion criteria were: studies that attended the goal proposed by this research and published from 2007 (year the PSE was created); primary studies; secondary studies, in the case of systematic reviews, meta-analyses and/or meta-syntheses; books and guidelines, published in indexed sources or in gray literature; open access studies from the portal of journals of the Coordination for the Improvement of Higher Education Personnel (capes), accessed through CAFe. There was no restriction regarding language, in order to find studies from different countries.

Exclusion criteria were: opinions, consensuses, retractions, editorials, websites, and ads. Duplicate articles were only considered once.

The search was carried out in the following databases: Latin American and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed, Web of Science, SCOPUS, Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and the Educational Resources Information Center (ERIC). Furthermore, in order to find other relevant studies, a search was conducted in Google Scholar (restricted to its first five pages).

The search expression was adjusted to the vocabulary of each database (DeCS, MeSH Terms, Emtree, Keywords and CINAHL Terms), with an advanced search strategy combining terms using the boolean operators (AND and OR). The search strategy was used in the databases Web of Science and MEDLINE DATABASES, being elected the third strategy with the greatest potential to retrieve studies (Chart 2).

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Chart 2 -
Search strategies used in databases - Recife, PE, Brazil, 2023.

Selection, analysis, and data processing

The search was conducted from March to May 2023, by two independent, blinded researchers, in all databases. The disagreements, if any, were mediated by a third researcher.

The studies that passed through this triage were classified as eligible, after duplicates were eliminated using the reference manager EndNote®. Results found were exported into Rayyan®, a software developed by Qatar Computing Research Institute (QCRI). This allowed a further verification of duplicates, and then studies were selected for inclusion by two blinded researchers, who read the titles, abstracts, and full texts.

A table with the articles in the sample was created in a data collection instrument elaborated by the first author of this study. This data was identified using a code (ID), combining the letter A and a number attributed in ascending order, starting at "1". They were grouped in a table that included the items: Identifier code (ID), methodology, year, database and objective, activities of the nurse in the school. Then, competences and skills were identified from the descriptions of the school nursing interventions and thematically separated into axes of action, as understood by the Single Health System (SUS) (prevention, promotion, education, and assistance), in the PSE.

Skills and competences are terms often used in the educational and professional context, but have different meanings. In this study, we used this concept as understood by the Ministry of Education (MEC), according to which the term "skills" refers to the operational dexterity to carry out specific tasks or activities. skills are generally achieved via training, practice, and experience, and are more closely associated with one's know-how¹¹.

Competence, in turn, is the capacity to align a broader set of pieces of knowledge, skills, and attitudes that enable one to act efficiently in the different contexts of a given activity. skills are broader and multidimensional, since they involve the integrated and specific application of social, emotional, cognitive, and ethical techniques, so a task can be executed with excellence¹².

From the description of each intervention from school nurses, we could infer that competence is an element that articulates a set of similar skills for a given purpose. In the reports of nursing skills, some conducts, often repeated when specific interventions took place, were identified as patterns and classified as essential competences for the practice of care in school contexts.

Then, these interventions were analyzed in detail, highlighting operational skills to execute the competence used in the intervention. Some of them are explicitly highlighted in the works found.

Using this analysis, we could understand the skills necessary for the effective work of nurses in educational environments, showing how a competence coordinates different skills for a practical resolution.

RESULTS

At first, our search found 72,132 records, 3 of which came from Google Scholar. After removing duplicates and implementing inclusion criteria, 634 remained to be selected according to title and abstract. In this stage, 597 were excluded, as they were not in accordance with pre-established criteria. This led to 37 studies being evaluated in full. In this stage, 17 studies were excluded, meaning that 20 were in accordance with all eligibility criteria and were thus included (Figure 1).

Figure 1 -
Flow of the study selection process for the scoping review based on the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) - Recife, PE, Brazil, 2023.

All 20 records included had been published in English. Regarding their origin, 12 were produced in the Americas, six in Europe, one in Asia, and one in Africa. As for their methods, 11 were quantitative, 2 were reviews or orientations based on bibliographic studies, and six were qualitative (Chart 3).

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Chart 3 -
Characterization of the records included. Recife, PE, Brazil, 2023.

The information from the papers found includes the competences and skills of nurses, directed at goals related to students' health, as well as technical and managerial recommendations, including: health promotion, health care, health prevention, and health education (Chart 4).

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Chart 4 -
Competences and skills of school nurses, thematic axes, and main results of the studies included. Recife, PE, Brazil, 2023.

Nursing Competences and skills in the School Health Service

Studies indicated that school nurse competences are encompassed in assertive interventions that require a deep knowledge about the profile and needs of student, as well as good management of human and material resources to reach their health objectives¹³^-¹⁶^,²³^,²⁷^,³¹. Competences for this include: Leadership¹⁴^,¹⁷^-¹⁹^,²²^,²⁴^,³¹; Management¹⁴^,¹⁹^,²⁰^,²²; Planning¹⁶^,²⁷^,³²; Communication¹³^-¹⁶^,¹⁷^,²⁰^,²³^-²⁶^,²⁸^-³²; Articulation and collaboration¹⁷^,¹⁸^,²⁵^,³⁰^,³²); Advocating for the individual or community¹⁷^-¹⁹); and Clinical expertise in health assessments ⁽¹⁵^-¹⁷^,²¹^,²⁴^,³².

The skills involved in the operationalization of these competences and in reaching these health demands are in accordance with a series of essential requisites to strengthen bonds between school, family, and health services. Skills that can be associated with this include: health guidance; embracing the individual, family or community; having the specific knowledge to manage health conditions; preparation to teach, develop and apply health policies; investigate, describe and monitor health events, refer and monitor health; triage and manage health needs; health counseling; perform nursing consultations; among others ¹³^-³¹^).

Skills presuppose a complete domain of theoretical-practical competences, and one is inferred from the other. The studies did not indicate a correlation or influence between competences and skills, but this can be suggested considering through the interpretation of the interventions recorded (Figure 2).

Figure 2 -
Competences and skills of school nurses, as inferred from the studies. Recife, PE, Brazil, 2023.

Health Education at School

Health education at school is objectively described as a the planning of activities that go against the shortcomings of each school public¹³^,¹⁴^,¹⁸, they are involved with socioeconomic, spiritual, and trans-cultural conditions of the community²⁵^,²⁶^,²⁸. The school nurse is successful in activities of health education when they teach about the care that is part of the reality of that group, with safety, autonomy, and in accordance with theoretical-technical bases¹⁷^,²⁹^-³¹.

Health education in the school health service was indicated as a general goal that tries to use important strategies to improve the health and wellbeing of students ¹⁸^,²¹^,²⁷, contributing for their integral development and the formation of conscious and responsible students²²^-²⁴. By providing the necessary information and skills for the promotion of health, this approach aims to improve the quality of life of students and promote a culture of health in the schools and communities²¹^-²⁶.

The topics related to health involve a set of vulnerabilities, such as personal hygiene, healthy eating, physical activity, disease prevention, sex education, drug and alcohol use, mental health, among others ¹³^,¹⁴^,¹⁷^,²⁵^,²⁸. These topics are addressed integrated with the school curriculum, in classes, lectures, projects, campaigns and extracurricular activities¹³^,¹⁴^,¹⁸^,²⁸.

Furthermore, the Health Education in the School Health Service seeks to promote an active participant from students and their families, encouraging them to take responsibility for their own health and engage in health promotion activities in and out of the school ²⁷^,²⁸.

School Health Prevention

Nursing has an essential role in prevention, in the School Health Services, contributing to promote the health and wellbeing of the students²⁰^,²¹. Nurses that work in this field are responsible for providing nursing care, health education, and preventive interventions for students.

The nurse has the important task of periodically examining the health of the students, in order to identify potential issues, such as visual and auditory deficiencies, posture issues, nutritional disorders, and others ³^,¹⁴^,¹⁷^,¹⁸^-²²^,²⁷^,²⁹. These examinations enable the early detection of issues and a proper intervention, helping prevent and treat health conditions¹³^,²⁷.

Nursing also has an important role in the administration of vaccines and immunizations. Furthermore, school nurses are prepared to deal with emergency situations and provide first aid ²⁵^,²⁸^,²⁹. They are trained to provide immediate care in case of lesions, accidents, or acute diseases that can take place during school hours. Their presence and readiness help ensure the safety and well-being of students¹⁴^,²¹^,²².

There is much emphasis on the identification and prevention of mental health issues among students. They are attentive to signs of anxiety, depression, bullying, and other emotional issues, and work in strict collaboration with mental health workers to provide students with the proper support (14^,²⁰^).

School Health Promotion

One of the roles of school nurses is in health promotion²¹. They provide, in addition to guidance, tools that enable the consolidation of healthy habits²⁴^-²⁶. These actions are essential to train students so they can make informed decisions about their health and adopt healthy habits as early as possible²⁹^,³⁰.

School health promotion involves from health education to the diagnosis or suspicion of health issues, vaccine administration, support to the management of chronic disease, and support to the mental health of students ²⁶. Its presence in the school environment contributes to the creation of a healthy environment, safe and conducive to learning, promoting the wellbeing of students and their ability to reach their full academic and personal potential¹⁶^-¹⁸.

School Health Nursing Care

The goal of school health nursing care is to promote and preserve the health of students, providing nursing care that is adequate to the environment¹⁴^,¹⁵. The actions of the nurse include preventive, curative, and rehabilitation measures, in order to ensure the wellbeing and healthy development of students¹⁹^,²⁰.

There are also reports of drug administration and basic nursing care in the school environment, since these are professionals trained to deal with emergencies such as falls, lesions, seizures, etc., providing first aid and dressing wounds, monitoring the intake of prescribed medication and guiding the students about health care¹⁴^,¹⁵^,¹⁷^,¹⁹^,²⁰.

The work of the nurse was seen as relevant in the conversations to provide guidance to parents and guardians¹⁷^,¹⁹, since these workers provide information about health care, clarify doubts, and guide them about preventive measures to be adopted at home¹⁴^,²⁰.

DISCUSSION

Skills are derived from the competence acquired, and are associated to a practical level, the know-how. Competences are related to the ability to carry out complex tasks and are conceptualized as the essential structures of our intellectual capacity. Thus, skills are the actions we performed as we establish connections and interactions with objects, situations, phenomena, and people we wish to understand. Our skills are improved and combine in the actions and operations we carry out, allowing for a new reorganization of existing competences³³.

By analyzing literature, we can perceive nursing praxis in schools as the operationalization of a set of competences and skills that affect health prevention and promotion, as well as health care and education. A multi-level intervention in the US school system found that school nurses managed to send students into the health system, so they could be attended in triages for sexually transmitted infections and for contraception, in addition to being offered condoms¹³.

In another study, the engagement of the nurse in a school environment was statistically significant, but more appreciated by girls than boys, not only as it helped deal with issues related to a healthy lifestyle, but also regarding sexuality, parenting, and marriage³⁴. Therefore, it can be noted that the presence of a school nurse would also be able to successfully provide sexual education at schools¹³^,²⁵^,²⁸^,³³.

Skills related to transformational and situational leadership of school nurses are culturally positive for school environments³¹. We found that leadership, which is a competence, helps develop care plans for the students. Therefore, international experience shows that nurses carry out interventions with students, parents, and workers at school, in order to promote the health and academic success of students¹⁴^,¹⁷^-¹⁹^,²²^,²⁴^,³¹^,³².

These activities help reduce school evasion, increase adherence to immunization, improve the management of chronic conditions, disease prevention, support identifying and managing mental disorders and health issues, as well as providing psychosocial support. Nevertheless, the scarcity of school nursing professionals makes it impossible to effectively implement these actions. This is an obstacle for the planning and continuity of intersectoral management³⁴^,³⁵.

In the actions to promote a healthy school environment in Denmark, a plan for the prevention of school violence, bullying, disasters, and terrorism was implemented²⁰. Thus, school nurses developed an essential role in the protection of children and youth³⁶. In Swedish studies, the nurse is seen as a key professional, who can identify early signs of maltreatment, provide emotional support, education the school community, and help other workers ensure the safety and wellbeing of children and adolescents in schools²³^,²⁶^,³⁷

Violence and bullying are significant issues that affect the physical and mental wellbeing of Brazilian students. Policies to raise awareness and prevent these issues, in addition to direct interventions, are essential to create safe and embracing school environments. The efficacy of these policies, however, varies widely, with some schools implementing robust programs, while others lack adequate resources and training³⁸.

Health education skills and practices that address topics such as nutrition, exercise, prevention and cessation of smoking, oral health, prevention of sexually transmitted infections and other infectious diseases, teenage pregnancy, parenting, and others are fundamental to reduce these events in the health of students¹³^,¹⁴^,¹⁷^,¹⁸^,²⁸.

Health education provided by school nurses can improve student knowledge and attitude regarding health, leading to healthier behaviors among students¹⁵^,³⁷^,³⁹. In addition to direct effects on the health of students, school nurse interventions were also associated to benefits in educational performance³⁹.

School nurses who work in school nursing offices, such as in the United States and Egypt, connect school personnel, the family, health workers, and the community¹⁷^,¹⁸^,²⁵. Additionally, the competence of management, which, in the case of student with health and resource administration issues, ensures that there is adequate communication and collaboration between family, health teams, students, and providers of community resources¹⁴^,²³^-²⁶. This is an essential interface, and the school nurse works with community organizations and the primary care team to transform the community into a healthy place for all children and families²⁵^,³⁰^,³².

Although school health services vary depending on territory, policy, culture, and resources, current school nurses are unprepared¹³^,¹⁶^,²⁵^,³⁹. According with the manual School Health: Policy and Practice, from the American Academy of Pediatrics (AAP), the following health services are the minimum that need to be offered: assessment of health complaints, drug administration, caring for students with special health needs; an emergency and urgency management system; mandatory health screening programs; verification of immunization and notification of infectious diseases; and identification and management of chronic health needs of students that can affect academic performance ⁴⁰.

The AAP recognizes the need for adequate management of the health conditions of the student in its policy statement, as well as the need for policies for medical emergencies that can affect school, and the role of the school nurse in the development and implementation of said policies⁴⁰. This professional works as an extension of the traditional health services of the community, ensuring professional continuity, adherence, and supervision of care in the school environment²⁷^,³⁷.

Activities which require the competences of intersectoral collaboration and communication, in order to better receive and provide health strategies, are related to the importance and quality of the bonds that must be created between school nurses and students, requiring abilities and flexibility in their approach¹³^-¹⁶^,³⁰^,³².

This phenomenon is observed as a result of six conducts: striving to establish bonds of trust; helping girls achieve insight into their situation; promoting support for a healthy life rhythm; being reliable when adolescents are in serious trouble; trying to minimize values and attitudes; and collaborating to support health and learning²⁶.

The National Association of School Nurses highlighted some broad, applicable functions, especially the triage and the referral of health conditions, this reducing the negative effects of health problems in education and identifying potential medical issues early. Triage includes, but is not limited to vision, hearing, and body mass index (BMI) evaluations⁴¹.

In the Brazilian context, we see a different aspect, which is the application of the principles of the SUS doctrine (equality, universality, and integrality), with the primary health care units functioning as the entrance to the regionalized and decentralized health care services, which can embrace and monitor students, in addition to referring them to specialized health services when needed. The implementation of PSE, among other initiatives (such as the National Program of Student Care), can have a significant influence on the role of the nurse, which is allocated in schools or visits them, which would align their actions with the strategies of SUS³^,⁴.

Furthermore, the school nurse must provide direct care to students, including a customized health plan for students with chronic conditions, and elaborate an emergency plan to deal with emergencies in the school environment, such as diabetes and asthma. This includes the care provided to children with special needs⁴².

In many contexts, the nurse is presented as the leader of the health team, and as such, they must coordinate the evaluation of the health growth and development of the student, identifying any health issues that may hinder their academic progress, and developing a health plan to manage any issues in the school environment²⁸^-³²^,⁴³^,⁴³.

A Greek study ¹⁶ indicated a moderate involvement in health promotion programs due to existing health policies, mainly defined by school personnel and State services. The lack of a legislative structure that determines which exactly are the responsibilities of a school nurse, led to a reduction of the involvement with health and health promotion activities¹⁶.

In Brazil, investments in school infrastructure, and in adequate, continuous programs for school health, show how unequally this service is provided throughout the territory. The scarcity in the training of health and education workers leads to interventions that are too fragmented and specific when it comes to implementing health policies at school⁴⁴.

School nurses from private institutions provide a significant amount of direct care, even if insurers do not give them financial support¹⁴^). Thus, as opposed to what is the case in Brazil, in the US a child is more likely to receive care from a school nurse than from a primary care service provider, showing that this category is more accessible when it comes to providing care to students²⁶^,²⁷.

Another study showed that many public schools in the US face challenges to provide effective nursing services⁴⁵. Many schools have too few nurses for their number of students, which can limit access to health care. Furthermore, the lack of funding and adequate resources may also affect the ability of school nurses to meet the needs of the students. The importance of effective policies and directives to support the practice of nursing in public schools stands out⁴⁵.

The World Health Organization⁴⁶ indicated the relevance of broad school health services that include health promotion, disease prevention, treatment, and support to students with health issues. School health services must be based on evidence, culturally adequate, and provided by well-trained health workers.

Although there are cultural and sociodemographic differences, certain challenges to school health are common to North-American countries, which have a private health system, and to countries such as the United Kingdom, Greece, Egypt, and Brazil, which have a free universal health system, namely, the insufficient resources to maintain continuous actions, and the lack of support or interest from parents and teachers¹⁵^,¹⁶^,²⁴^,²⁵^,³⁰. Thus, incentives to the regular promotion of health, improvement of skills, and the incorporation of health education in school curricula are strategies to achieve a higher quality in the promotion of child health⁴⁷.

Although school nurses are often pointed out as essential for health and education, communities are aware that they could provide more services, were they given resources and time to do so¹³^,²⁵^-²⁸. Due to the lack of rigorous studies, it became difficult to measure the impact of the interventions in the mental health results of students, meaning that nurses continue to feel unprepared and unsupported in this regard ¹³^,⁴⁶.

Therefore, the utilization of health services during school routine raises questions about its impact on academic and health results. Although we do not propose to create a separate health sector within schools, it is adequate to improve the provision of health care actions. This reduces the possibility of school nurses and primary care workers to promote the health of students. It is essential to improve the systems and networks of communication and intersectoral articulation.

Due to the time frame selected, some relevant studies may not have been included in the literature review. Nevertheless, we believe this exclusion would not have had a substantial impact in the results, considering the fact that we reached data saturation. Finally, one of the most notable limitations of this study is the variation in the understanding of what are the responsibilities of nurses in Brazilian educational environments, as well as that of the term "school nursing". This makes it harder to synthesize consistent and wide-ranging evidence, highlighting the need for further research that evaluate these practices and competences in the Brazilian school setting, to (re)formulate public policies that are more effective and inclusive.

CONCLUSION

The competences and skills of nurses in school health services were mapped onto the strategies and interventions used by these workers, who were mostly established in the international setting, being essential for an assertive attitude in health, and for the academic performance of children and adolescents. These competences and skills are: communication, clinical expertise, leadership, articulation and collaboration, management, advocating for the patient/community, and planning.

Considering the contextualization of school nursing practice, it was possible to find successful international experiences, potentially encouraging and strengthening integration between health and education, and improving health results in the school environment. Nevertheless, due to the fact that the role of school nurse is yet to be formally created in Brazil, and the fact that there are shortcomings in the way the term "school nursing" is understood in the country, we recommend future research to investigate the practices of nurses who are working in the field of student public policies, in addition to a better definition of the concept of school nursing.

REFERENCES

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» https://rsdjournal.org/index.php/rsd/article/view/18089
2. Rasche AS, Santos MSS. Enfermagem escolar e sua especialização: uma nova ou antiga atividade? Rev Esc Enferm USP. 2011;45(1):257-62. https://doi.org/10.1590/S0034-71672013000400022
» https://doi.org/10.1590/S0034-71672013000400022
3. Yosep I, Hikmat R, Mardhiyah A. School-Based nursing interventions for preventing bullying and reducing its incidence on students: a scoping review. Int J Environ Res Public Health. 2023;20(2):1577. https://doi.org/10.3390/ijerph20021577
» https://doi.org/10.3390/ijerph20021577
4. Presidência da República (BR). Decreto nº. 6.286, de 5 de dezembro de 2007. Institui o Programa Saúde na Escola - PSE, e dá outras providências [Internet]. Diário Oficial da União; 2007[cited 2023 Apr 21]. Available from: https://www.planalto.gov.br/ccivil_03/_ato2007-2010/2007/decreto/d6286.htm
» https://www.planalto.gov.br/ccivil_03/_ato2007-2010/2007/decreto/d6286.htm
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6. Joias LD, Mendes AA, Daré MF, Fonseca LM, Domingues AN. Práticas educativas do enfermeiro no contexto da saúde escolar: revisão integrativa da literatura. Rev Bras Multidiscip. 2020;23(2Supl.). https://doi.org/10.25061/2527-2675/rebram/2020.v23i2supl..876
» https://doi.org/10.25061/2527-2675/rebram/2020.v23i2supl..876
7. Duarte C, Silva RM, Galvão MTG. A privatização da atenção primária à saúde no Brasil: riscos e desafios para o Sistema Único de Saúde. Rev Panam Salud Publica. 2018;42
8. Organização das Nações Unidas (ONU). Resolução A/RES/70/1. Transformando o nosso mundo: a agenda 2030 para o desenvolvimento sustentável[Internet]. Nova Iorque: UN; 2015[cited 2023 Apr 21]. Available from: https://nacoesunidas.org/wp-content/uploads/2015/10/agenda2030-pt-br.pdf
» https://nacoesunidas.org/wp-content/uploads/2015/10/agenda2030-pt-br.pdf
9. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73. https://doi.org/10.7326/M18-0850
» https://doi.org/10.7326/M18-0850
10. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Munn Z, editors. Joanna Briggs Institute manual for evidence synthesis [Internet]. Adelaide: JBI; 2020 [cited 2023 Apr 20]. Available from: https://synthesismanual.jbi.global
» https://synthesismanual.jbi.global
11. Deffune D, Depresbiteris L. Competências, habilidades e currículos de educação profissional: crônicas e reflexões. São Paulo: Senac; 2019. 108p.
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» https://doi.org/10.18764/2358-4319.v12n2p210-227
13. Dittus P, De Rosa C, Jeffries R, Afifi A, Cumberland W, Ethier K, et al. O5-S1.01 Employing school nurses as a healthcare point of contact for male high school students: a school-based intervention to prevent STD, HIV, and teen pregnancy. Sex Transm Infect. 2011;87:A88-A89. https://doi.org/10.1136/sextrans-2011-050109.151
» https://doi.org/10.1136/sextrans-2011-050109.151
14. Magalnick H, Mazyck D. Role of the school nurse in providing school health services. Pediatr. 2008;121(5):1052-6. https://doi.org/10.1542/peds.2008-0382
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15. Schainker E, O'Brien MJ, Fox D, Bauchner H. School nursing services: use in an urban public school system. Arch Pediatr Adolesc Med. 2005;159(1):83-7. https://doi.org/10.1001/archpedi.159.1.83
» https://doi.org/10.1001/archpedi.159.1.83
16. Alexandropoulou M, Sourtzi P, Kalokerinou A. Health promotion practices and attitudes among nurses in special education schools in Greece. J Sch Nurs. 2010;26(4):278-88. https://doi.org/10.1177/1059840510374879
» https://doi.org/10.1177/1059840510374879
17. Anderson LJW, Schaffer MA, Hiltz C, O’Leary SA, Luehr RE, Yoney EL. Public health interventions: school nurse practice stories. J Sch Nurs. 2017;34(3):192-202. https://doi.org/10.1177/1059840517721951
» https://doi.org/10.1177/1059840517721951
18. Barrett MS. Identification of health education competency in school nurse certification programs: multiple case study [Internet]. Indiana University of Pennsylvania ProQuest Dissertations Publishing ; 2017[cited 2023 Apr 21]:e10642347. Available from: http://www.proquest.com/en-US/products/dissertations/individuals.shtml
» http://www.proquest.com/en-US/products/dissertations/individuals.shtml
19. Bobo N, Kaup T, McCarty P, Carlson JP. Diabetes management at school: application of the healthy learner model. J Sch Nurs. 2010;27(3):171-84. https://doi.org/10.1177/1059840510394190
» https://doi.org/10.1177/1059840510394190
20. Borup I, Holstein BE. Schoolchildren who are victims of bullying report benefit from health dialogues with the school health nurse. Health Educ J. 2007;66(1):58-67. https://doi.org/10.1177/0017896907073787
» https://doi.org/10.1177/0017896907073787
21. Brackney, DE, Cutshall, M. Prevention of type 2 diabetes among youth: a systematic review, implications for the school nurse. J Sch Nurs. 2015;31:6-21 https://doi.org/10.1177/1059840514535445
» https://doi.org/10.1177/1059840514535445
22. Hillemeier MM, Davis LA, Smith CA. School nurses on the front line: challenges in meeting the diverse health needs of rural Pennsylvania school children [Internet]. Harrisburg Center for Rural Pennsylvania; 2006[cited 2023 Apr 21]. Available from: https://files.eric.ed.gov/fulltext/ED540870.pdf
» https://files.eric.ed.gov/fulltext/ED540870.pdf
23. Kim RE, Becker KD, Stephan SH, Hakimian S, Apocada D, Escudero PV, Chorpita BF. Connecting students to mental health care: Pilot findings from an engagement program for school nurses. Advances in School Mental Health Promotion, 2015;8(2):87-103. https://doi.org/10.1080/1754730X.2015.1021821
» https://doi.org/10.1080/1754730X.2015.1021821
24. Leidner A, Maughan E, Bjork A, Black C, Mazyck D, Underwood J. Vaccination-related activities at schools with kindergartners: evidence from a school nurse survey. J School Nurs. 2020;36(6):464-71. https://doi.org/10.1177/1059840519847730
» https://doi.org/10.1177/1059840519847730
25. Farrag S, Hayter M. A qualitative study of Egyptian School Nurses’ attitudes and experiences toward sex and relationship education. J Sch Nurs. 2013;30(1):49-56. https://doi.org/10.1177/1059840513506941
» https://doi.org/10.1177/1059840513506941
26. Larsson M, Björk M, Ekebergh M, Sundler AJ. Striving to make a positive difference: school nurses’ experiences of promoting the health and well-being of adolescent girls. J Sch Nurs. 2014;30(5):358-65. https://doi.org/10.1177/1059840513505223
» https://doi.org/10.1177/1059840513505223
27. Morrison-Sandberg LF, Kubik MY, Johnson KE. Obesity prevention practices of elementary school nurses in Minnesota. J Sch Nurs. 2010;27(1):13-21. https://doi.org/10.1177/1059840510386380
» https://doi.org/10.1177/1059840510386380
28. Chang Y-T, Hayter M, Lin M-L. Experiences of sexual harassment among elementary school students in Taiwan: implications for school nurses. J Sch Nurs. 2010;26(2):147-55. https://doi.org/10.1177/1059840509355585
» https://doi.org/10.1177/1059840509355585
29. Ellertsson AS, Garmy P, Clausson EK. Health among schoolchildren from the school nurse’s perspective. J Sch Nurs. 2017;33(5):337-43. https://doi.org/10.1177/1059840516676876
» https://doi.org/10.1177/1059840516676876
30. Hayter M, Owen J, Cooke J. Developing and establishing school-based sexual health services. J Sch Nurs. 2012; 28(6):433-41. https://doi.org/10.1177/1059840512444317
» https://doi.org/10.1177/1059840512444317
31. Ladd VJ. School nurses: positive deviant leaders in the school setting. J Sch Nurs. 2009;25(1): 6-14. https://doi.org/10.1177/1059840508327628
» https://doi.org/10.1177/1059840508327628
32. Muniz EA, Queiroz MVO, Pinheiro PNC, Silva MRF, Moreira TMM, Oliveira EN, et al. School Nursing Guide for student health promotion: construction and validity. Rev Bras Enferm. 2023;76(1):e20220260. https://doi.org/10.1590/0034-7167-2022-0260pt
» https://doi.org/10.1590/0034-7167-2022-0260pt
33. Ministério da Saúde (BR), Ministério da Educação. Programa Saúde na Escola [Internet]. Brasília: Ministério da Saúde ; 2007[cited 2023 Apr 21]. Available from: http://portal.mec.gov.br/index.php?option=com_docman&view=download&alias=1726-saudenaescola-decreto6286-pdf&category_slug=documentos-pdf&Itemid=30192
» http://portal.mec.gov.br/index.php?option=com_docman&view=download&alias=1726-saudenaescola-decreto6286-pdf&category_slug=documentos-pdf&Itemid=30192
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Edited by

Associate editor:
Gabriella de Andrade Boska

Editor-in-chief:
João Lucas Campos de Oliveira

Publication Dates

Publication in this collection
10 Mar 2025
Date of issue
2025

History

Received
02 Feb 2024
Accepted
20 Aug 2024

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] 1. Bastos PO, Moreira Junior JJ, Norjosa MES, Vasconcelos MJC, Queiroz ML. Performance of Brazilian nurses in the school environment: narrative review. RSD [Internet]. 2021 [cited 2023 Apr 20];10(9):e31410918089. Available from: https://rsdjournal.org/index.php/rsd/article/view/18089
» https://rsdjournal.org/index.php/rsd/article/view/18089

[2] 2. Rasche AS, Santos MSS. Enfermagem escolar e sua especialização: uma nova ou antiga atividade? Rev Esc Enferm USP. 2011;45(1):257-62. https://doi.org/10.1590/S0034-71672013000400022
» https://doi.org/10.1590/S0034-71672013000400022

[3] 3. Yosep I, Hikmat R, Mardhiyah A. School-Based nursing interventions for preventing bullying and reducing its incidence on students: a scoping review. Int J Environ Res Public Health. 2023;20(2):1577. https://doi.org/10.3390/ijerph20021577
» https://doi.org/10.3390/ijerph20021577

[4] 4. Presidência da República (BR). Decreto nº. 6.286, de 5 de dezembro de 2007. Institui o Programa Saúde na Escola - PSE, e dá outras providências [Internet]. Diário Oficial da União; 2007[cited 2023 Apr 21]. Available from: https://www.planalto.gov.br/ccivil_03/_ato2007-2010/2007/decreto/d6286.htm
» https://www.planalto.gov.br/ccivil_03/_ato2007-2010/2007/decreto/d6286.htm

[5] 5. Ministério da Saúde (BR). Ministério da Educação. Programa Saúde na Escola [Internet]. Brasília: Ministério da Saúde; 2011[cited 2023 Apr 21]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/passo_a_passo_programa_saude_escola.pdf
» https://bvsms.saude.gov.br/bvs/publicacoes/passo_a_passo_programa_saude_escola.pdf

[6] 6. Joias LD, Mendes AA, Daré MF, Fonseca LM, Domingues AN. Práticas educativas do enfermeiro no contexto da saúde escolar: revisão integrativa da literatura. Rev Bras Multidiscip. 2020;23(2Supl.). https://doi.org/10.25061/2527-2675/rebram/2020.v23i2supl..876
» https://doi.org/10.25061/2527-2675/rebram/2020.v23i2supl..876

[7] 7. Duarte C, Silva RM, Galvão MTG. A privatização da atenção primária à saúde no Brasil: riscos e desafios para o Sistema Único de Saúde. Rev Panam Salud Publica. 2018;42

[8] 8. Organização das Nações Unidas (ONU). Resolução A/RES/70/1. Transformando o nosso mundo: a agenda 2030 para o desenvolvimento sustentável[Internet]. Nova Iorque: UN; 2015[cited 2023 Apr 21]. Available from: https://nacoesunidas.org/wp-content/uploads/2015/10/agenda2030-pt-br.pdf
» https://nacoesunidas.org/wp-content/uploads/2015/10/agenda2030-pt-br.pdf

[9] 9. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73. https://doi.org/10.7326/M18-0850
» https://doi.org/10.7326/M18-0850

[10] 10. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Munn Z, editors. Joanna Briggs Institute manual for evidence synthesis [Internet]. Adelaide: JBI; 2020 [cited 2023 Apr 20]. Available from: https://synthesismanual.jbi.global
» https://synthesismanual.jbi.global

[11] 11. Deffune D, Depresbiteris L. Competências, habilidades e currículos de educação profissional: crônicas e reflexões. São Paulo: Senac; 2019. 108p.

[12] 12. Neitzel O, Schwengber IL. Os conceitos de capacidade, habilidade e competência e a BNCC. Rev Educ Emancip. 2019;12(2):210-27. https://doi.org/10.18764/2358-4319.v12n2p210-227
» https://doi.org/10.18764/2358-4319.v12n2p210-227

[13] 13. Dittus P, De Rosa C, Jeffries R, Afifi A, Cumberland W, Ethier K, et al. O5-S1.01 Employing school nurses as a healthcare point of contact for male high school students: a school-based intervention to prevent STD, HIV, and teen pregnancy. Sex Transm Infect. 2011;87:A88-A89. https://doi.org/10.1136/sextrans-2011-050109.151
» https://doi.org/10.1136/sextrans-2011-050109.151

[14] 14. Magalnick H, Mazyck D. Role of the school nurse in providing school health services. Pediatr. 2008;121(5):1052-6. https://doi.org/10.1542/peds.2008-0382
» https://doi.org/10.1542/peds.2008-0382

[15] 15. Schainker E, O'Brien MJ, Fox D, Bauchner H. School nursing services: use in an urban public school system. Arch Pediatr Adolesc Med. 2005;159(1):83-7. https://doi.org/10.1001/archpedi.159.1.83
» https://doi.org/10.1001/archpedi.159.1.83

[16] 16. Alexandropoulou M, Sourtzi P, Kalokerinou A. Health promotion practices and attitudes among nurses in special education schools in Greece. J Sch Nurs. 2010;26(4):278-88. https://doi.org/10.1177/1059840510374879
» https://doi.org/10.1177/1059840510374879

[17] 17. Anderson LJW, Schaffer MA, Hiltz C, O’Leary SA, Luehr RE, Yoney EL. Public health interventions: school nurse practice stories. J Sch Nurs. 2017;34(3):192-202. https://doi.org/10.1177/1059840517721951
» https://doi.org/10.1177/1059840517721951

[18] 18. Barrett MS. Identification of health education competency in school nurse certification programs: multiple case study [Internet]. Indiana University of Pennsylvania ProQuest Dissertations Publishing ; 2017[cited 2023 Apr 21]:e10642347. Available from: http://www.proquest.com/en-US/products/dissertations/individuals.shtml
» http://www.proquest.com/en-US/products/dissertations/individuals.shtml

[19] 19. Bobo N, Kaup T, McCarty P, Carlson JP. Diabetes management at school: application of the healthy learner model. J Sch Nurs. 2010;27(3):171-84. https://doi.org/10.1177/1059840510394190
» https://doi.org/10.1177/1059840510394190

[20] 20. Borup I, Holstein BE. Schoolchildren who are victims of bullying report benefit from health dialogues with the school health nurse. Health Educ J. 2007;66(1):58-67. https://doi.org/10.1177/0017896907073787
» https://doi.org/10.1177/0017896907073787

[21] 21. Brackney, DE, Cutshall, M. Prevention of type 2 diabetes among youth: a systematic review, implications for the school nurse. J Sch Nurs. 2015;31:6-21 https://doi.org/10.1177/1059840514535445
» https://doi.org/10.1177/1059840514535445

[22] 22. Hillemeier MM, Davis LA, Smith CA. School nurses on the front line: challenges in meeting the diverse health needs of rural Pennsylvania school children [Internet]. Harrisburg Center for Rural Pennsylvania; 2006[cited 2023 Apr 21]. Available from: https://files.eric.ed.gov/fulltext/ED540870.pdf
» https://files.eric.ed.gov/fulltext/ED540870.pdf

[23] 23. Kim RE, Becker KD, Stephan SH, Hakimian S, Apocada D, Escudero PV, Chorpita BF. Connecting students to mental health care: Pilot findings from an engagement program for school nurses. Advances in School Mental Health Promotion, 2015;8(2):87-103. https://doi.org/10.1080/1754730X.2015.1021821
» https://doi.org/10.1080/1754730X.2015.1021821

[24] 24. Leidner A, Maughan E, Bjork A, Black C, Mazyck D, Underwood J. Vaccination-related activities at schools with kindergartners: evidence from a school nurse survey. J School Nurs. 2020;36(6):464-71. https://doi.org/10.1177/1059840519847730
» https://doi.org/10.1177/1059840519847730

[25] 25. Farrag S, Hayter M. A qualitative study of Egyptian School Nurses’ attitudes and experiences toward sex and relationship education. J Sch Nurs. 2013;30(1):49-56. https://doi.org/10.1177/1059840513506941
» https://doi.org/10.1177/1059840513506941

[26] 26. Larsson M, Björk M, Ekebergh M, Sundler AJ. Striving to make a positive difference: school nurses’ experiences of promoting the health and well-being of adolescent girls. J Sch Nurs. 2014;30(5):358-65. https://doi.org/10.1177/1059840513505223
» https://doi.org/10.1177/1059840513505223

[27] 27. Morrison-Sandberg LF, Kubik MY, Johnson KE. Obesity prevention practices of elementary school nurses in Minnesota. J Sch Nurs. 2010;27(1):13-21. https://doi.org/10.1177/1059840510386380
» https://doi.org/10.1177/1059840510386380

[28] 28. Chang Y-T, Hayter M, Lin M-L. Experiences of sexual harassment among elementary school students in Taiwan: implications for school nurses. J Sch Nurs. 2010;26(2):147-55. https://doi.org/10.1177/1059840509355585
» https://doi.org/10.1177/1059840509355585

[29] 29. Ellertsson AS, Garmy P, Clausson EK. Health among schoolchildren from the school nurse’s perspective. J Sch Nurs. 2017;33(5):337-43. https://doi.org/10.1177/1059840516676876
» https://doi.org/10.1177/1059840516676876

[30] 30. Hayter M, Owen J, Cooke J. Developing and establishing school-based sexual health services. J Sch Nurs. 2012; 28(6):433-41. https://doi.org/10.1177/1059840512444317
» https://doi.org/10.1177/1059840512444317

[31] 31. Ladd VJ. School nurses: positive deviant leaders in the school setting. J Sch Nurs. 2009;25(1): 6-14. https://doi.org/10.1177/1059840508327628
» https://doi.org/10.1177/1059840508327628

[32] 32. Muniz EA, Queiroz MVO, Pinheiro PNC, Silva MRF, Moreira TMM, Oliveira EN, et al. School Nursing Guide for student health promotion: construction and validity. Rev Bras Enferm. 2023;76(1):e20220260. https://doi.org/10.1590/0034-7167-2022-0260pt
» https://doi.org/10.1590/0034-7167-2022-0260pt

[33] 33. Ministério da Saúde (BR), Ministério da Educação. Programa Saúde na Escola [Internet]. Brasília: Ministério da Saúde ; 2007[cited 2023 Apr 21]. Available from: http://portal.mec.gov.br/index.php?option=com_docman&view=download&alias=1726-saudenaescola-decreto6286-pdf&category_slug=documentos-pdf&Itemid=30192
» http://portal.mec.gov.br/index.php?option=com_docman&view=download&alias=1726-saudenaescola-decreto6286-pdf&category_slug=documentos-pdf&Itemid=30192

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PCC		DeCS/MeSH
P - population	Nurse	Nurse
C - Concept	Professional competences and skills	“Professional Competence”; “Health Education”; “Health Promotion”
C - Context	Health actions in schools	“School Nursing”; “Health Promotion”; “School Health Services”

ID	Methodology/ Year / Database	Country / Language	Objective
A1(¹³	Intervention study/ 2011 / EMBASE	United States / English	To evaluate the effects of the presence of school nurses as a point of access to health for high school students, in order to prevent STDs, HIV, and teenage pregnancy.
A2(¹⁴	Guideline based on bibliographic reviews/ 2008/ Google Scholar	United States / English	Not described.
A3(¹⁵	Intervention study/ 2005 / Google Scholar	United States / English	To describe the number and type of school health services provided by nurses in Boston Public Schools.
A4(¹⁶⁾	Cross-sectional study/ 2005 / MEDLIN	Greece / English	To evaluate the involvement of nurses from special education schools in health promotion activities, examine their attitudes in this regard, and explore factors that influence their practices.
A5(¹⁷	Qualitative focus group study/ 2018 / MEDLINE	United States / English	To describe and analyze the experiences of school nurses, and how well they understand and use public health interventions from the Public Health Intervention Wheel.
A6(¹⁸	Dissertation based on a multi-case study / 2017 / MEDLINE	United States / English	To explore and describe activities related to health education competency in the classroom and in clinical environments, within the certification programs of school nurses.
A7(¹⁹	Experience report/ 2011 / Medline	United States / English	To describe how the Healthy Student Model was used to improve the practical ability of school nurses to provide effective and consistent care when providing attention to students with diabetes.
A8(²⁰	Cross-sectional study/ 2007/ ERIC	Denmark / English	To find information about the health of school-age children, and their health behavior in their social context of health.
A9 (²¹	Systematic Review/ 2015 / ERIC	United States / English	To determine the effectiveness of non-pharmacological interventions to prevent type 2 diabetes in youth.
A10²²	Evaluation report/ 2007 / ERIC	United States / English	To identify and evaluate the standards of the state policy for nurses in Pennsylvania schools.
A11²³⁾	Cross-sectional study/ 2015/ SCOPUS	United States / English	To evaluate the viability, acceptability, and preliminary effectiveness of training to improve the strategies used by school nurses to involve youth in Mental Health Services.
A12²⁴	Quantitative study/ 2020/ ERIC	United States / /English	To understand the types of vaccination activities carried out in the schools, in order to better understand factors that can contribute for differences in vaccine coverage, undervaccinated groups of students, and their implications for parents, in addition to the attitudes of communities about vaccines.
A13 ²⁵	Qualitative study and thematic analysis/ 2013 / MEDLINE	Egypt, English	To address gaps and make suggestions about the path school nursing and sexual education should follow in Egyptian schools.
A14 ²⁶	Phenomenological study/ 2014 / SCOPUS	Sweden / English	To illuminate the experiences of school nurses when promoting the health and wellbeing of female adolescents.
A15²⁷	Cross-sectional study/ 2010 / MEDLINE	United States / English	To obtain information about the current school nursing practices related to obesity in primary schools from Minnesota, opinions about the obesity prevention programs led by school nurses, and the interests of school nurses in implementing programs that prevent obesity.
A16²⁸	Qualitative experience study / 2010 / MEDLINE	Taiwan / English	To explore students' experiences of sexual harassment.
A17²⁹	Cross-sectional study/ 2017/ ERIC	Sweden / English	To investigate the perception of Swedish school nurses in regard to the health of school-aged children.
A18³⁰	Qualitative experience study / 2021/ Web of Science	United Kingdom / English	To explore the experiences of health workers and policymakers involved in the creation of these services in United Kingdom schools.
A1⁹ ³¹⁾	Theoretical Essay/ 2009/ Web of Science	United Kingdom / English	To give support to the idea that school nurses can be positive deviants in the school environment.
A20³²	Methodological Study/ 2022/ Google Scholar	Brazil / Portuguese	To describe the construction and validation process of a School Nursing Guide to promote the health of young students.

ID	Competences	skills	Axes
A1(¹³	Communication	Embracing and orienting about health	Health promotion, health education, and health prevention.
A2(¹⁴	Planning, leadership, communication, health risk management.	Health assessment and care, development and application of individualized health care programs for the school population, work integration in the school community.	Health promotion; health education; health care and health prevention.
A3(¹⁵	Communication, clinical examination.	Monitor symptoms, guide medication adherence, share health knowledge, and reinforce positive attitudes and behaviors daily.	Health care.
A4(¹⁶⁾	Communication, planning health promotion activities, clinical examination.	Clinical diagnostic and assessment skills, identify and respond to the needs of students, development and application of individualized health promotion programs for the school population, integrate their work in the school community.	Health promotion.
A5(¹⁷	Articulating collaboration and coalition of services and sectors to protect the health of the individual or community, leadership, advocating for the individual or community.	Development and application of school health policies, describing and monitoring health events, investigating diseases and other health events, referring and monitoring health, screening and managing health needs, advising on health, conducting nursing consultations.	Health promotion; care; health prevention and health education.
A6(¹⁸	Communication, advocating for the individual or community, leadership, articulating and collaborating with other sectors and family.	Health education, development and application of individualized health care programs for the school population, work integration in the school community, negotiating better conditions, and attending the school population.	Health promotion and health education.
A7(¹⁹	Leadership, resource management and care, advocating for the individual or community.	Providing guidance and orientations in health, negotiating better conditions, and attending the school population.	Health care.
A8(²⁰	Communication, management of complex health problems.	Embracing and providing guidance about health, managing events that represent a risk to health.	Health care; prevention.
A9 (²¹	Clinical examination	Understanding and performing interventions that can achieve health goals.	Health promotion and disease prevention.
A10²²	Leadership in the development of school health programs and policies, management of complex health problems.	Identifying and responding to students' needs, development and application of individualized health promotion programs for the school population, understanding and performing interventions that can achieve health goals.	Health promotion and disease prevention.
A11²³⁾	Communication	Embracing adolescents in mental health services, teach about health.	Health promotion.
A1² ²⁴	Communication and leadership, clinical examination.	Understanding immunization activities, health education, providing guidance about health, showing initiative to implement health actions.	Health promotion.
A13 ²⁵	Communication, articulating and collaborating with other sectors and family.	Embracing and providing guidance, health education, proposing partnerships between actors and managers for health promotion.	Health promotion.
A14 ²⁶	Communication	Embracing and providing guidance about health, establishing bonds of trust with the teenage public.	Health promotion.
A15²⁷	Clinical examination in health evaluations, planning of activities for health prevention.	Understanding and performing interventions that can achieve health goals.	Health prevention.
A16²⁸	Communication	Embracing and providing guidance about health, health education.	Health education
A17²⁹	Communication	Embracing health needs, providing guidance and orientation in health.	Health prevention; Health promotion.
A18³⁰	Communication, articulating collaboration and coalition of services and sectors to protect the health of the individual or community.	Embracing and providing guidance in health, proposing partnerships between actors and managers for health promotion.	Health Promotion.
A19³¹⁾	Leadership, Communication	Embracing and providing guidance about health, health education, showing initiative to implement health actions.	Health Promotion.
A20³²	Communication, planning health promotion activities, clinical examination, articulating collaboration and coalition of services and sectors to protect the health of the individual or community.	Clinical, diagnostic, and assessment skills, identifying and responding to the needs of students, developing and applying individualized health promotion programs for the school population, understanding and performing interventions that can achieve health goals, proposing partnership between actors and managers for health promotion.	Health promotion.

DATABASES	SEARCH STRATEGY
LILACS	(((((((((Professional Competence[All Fields]) OR (Competence, Professional[All Fields])) AND (Health Education[All Fields])) OR (Education, Health[All Fields])) OR (Community Health Education[All Fields])) AND (School Nursing[All Fields])) OR (School Nursings[All Fields])) OR (School Health Services[All Fields])) AND (Health Promotion[All Fields])) AND (Nurse[All Fields])
MEDLINE	(((((((((Professional Competence[All Fields]) OR (Competence, Professional[All Fields])) AND (Health Education[All Fields])) OR (Education, Health[All Fields])) OR (Community Health Education[All Fields])) AND (School. Nursing[All Fields])) OR (School Nursings[All Fields])) OR (School Health Services[All Fields])) AND (Health Promotion[All Fields])) AND (Nurse[All Fields])
Web of Science	ALL=((((((((((Professional Competence) OR (Competence, Professional)) AND (Health Education)) OR (Education, Health)) OR (Community Health Education)) AND (School Nursing)) OR (School Nursings)) OR (School Health Services)) AND (Health Promotion)) AND (Nurse))
SCOPUS	(((((((((Professional Competence[All Fields]) OR (Competence, Professional[All Fields])) AND (Health Education[All Fields])) OR (Education, Health[All Fields])) OR (Community Health Education[All Fields])) AND (School Nursing[All Fields])) OR (School Nursings[All Fields])) OR (School Health Services[All Fields])) AND (Health Promotion[All Fields])) AND (Nurse[All Fields])
Science Direct	(((((((((Professional Competence[All Fields]) OR (Competence, Professional[All Fields])) AND (Health Education[All Fields])) OR (Education, Health[All Fields])) OR (Community Health Education[All Fields])) AND (School Nursing[All Fields])) OR (School Nursings[All Fields])) OR (School Health Services[All Fields])) AND (Health Promotion[All Fields])) AND (Nurse[All Fields])
CINAHL	(((((((((Professional Competence[All Fields]) OR (Competence, Professional[All Fields])) AND (Health Education[All Fields])) OR (Education, Health[All Fields])) OR (Community Health Education[All Fields])) AND (School Nursing[All Fields])) OR (School Nursings[All Fields])) OR (School Health Services[All Fields])) AND (Health Promotion[All Fields])) AND (Nurse[All Fields])
Embase	((((((((((Professional Competence) OR (Competence, Professional)) AND (Health Education)) OR (Education, Health)) OR (Community Health Education)) AND (School Nursing)) OR (School Nursings)) OR (School Health Services)) AND (Health Promotion)) AND (Nurse))
ERIC	((((((((((Professional Competence) OR (Competence, Professional)) AND (Health Education)) OR (Education, Health)) OR (Community Health Education)) AND (School Nursing)) OR (School Nursings)) OR (School Health Services)) AND (Health Promotion)) AND (Nurse))

Competences and skills of nurses in school health: a scoping review

Competencias y habilidades de las enfermeras en salud escolar: revisión del alcance

ABSTRACT

RESUMO

RESUMEN

INTRODUCTION

METHOD

Study design

Research Question, Search, and Inclusion Criteria

Selection, analysis, and data processing

RESULTS

Nursing Competences and skills in the School Health Service

Health Education at School

School Health Prevention

School Health Promotion

School Health Nursing Care

DISCUSSION

CONCLUSION

REFERENCES

Edited by

Publication Dates

History