Technology-mediated training programs for school health teams on special health care needs: a scoping review

Maria do Céu Coelho Monteiro Pires; Maria do Céu Aguiar Barbieri - Figueiredo; Daniela Filipa Batista Cardoso; Filipa Margarida Duque; Maria Sandra Tricas-Sauras; Mirko Prosen; Eva Guilherme Menino

doi:10.1590/1980-220X-REEUSP-2024-0328en

. 2025 May 9;59:e20240328. doi: 10.1590/1980-220X-REEUSP-2024-0328en

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Technology-mediated training programs for school health teams on special health care needs: a scoping review

Maria do Céu Coelho Monteiro Pires ^1,², Maria do Céu Aguiar Barbieri - Figueiredo ^1,³, Daniela Filipa Batista Cardoso ⁴, Filipa Margarida Duque ⁵, Maria Sandra Tricas-Sauras ⁶, Mirko Prosen ⁷, Eva Guilherme Menino ⁸

PMCID: PMC12064086 PMID: 40341907

ABSTRACT

Objective:

To map technology-mediated training programs for school health teams that address special health needs in the school environment and to identify their characteristics.

Method:

The review followed the JBI methodology. Eight databases were searched for published and gray literature. Studies published in Portuguese, English or Spanish since 2000 were included to capture emerging training programs.

Results:

Of the 1,106 studies identified, 29 were reviewed in full and eight were included in the final analysis. All studies were carried out in the United States of America. Program topics included chronic health conditions such as diabetes, asthma, procedures, as well as emergency situations, all aimed at school nurses and based on a conceptual or pedagogical framework. The programs included thematic modules of various lengths and offered online and hybrid training through various digital educational resources.

Conclusions:

Programs focused on chronic health conditions and assessed professionals' knowledge, skill development, self-efficacy, and confidence; few studies provided a detailed exploration of the underlying pedagogical models and did not use formative assessment.

DESCRIPTORS: School Health Services, Child Health, Professional Training, Educational Technology, School Nursing

INTRODUCTION

School plays a central role in children and young people’s lives. In addition to promoting education, it is also responsible for promoting health and well-being, as students spend a large part of their time in the school environment^(1–4). The American Academy of Pediatrics (AAP) defines children and youth with special health care needs (CSHCN) as those who have, or are at risk of developing chronic conditions that require health care and specialized services⁽⁵⁾. These children face disadvantages in the school environment, with a higher risk of exclusion from educational and social activities, which can negatively impact their academic performance^(6–9). The integration of health and education is therefore essential to create a universal health cycle, ensuring access to inclusive and quality education for all children, regardless of their health conditions^(10,11).

According to the World Health Organization (WHO), school health services are provided by health professionals within schools or in collaboration with external services⁽⁴⁾. Although the composition of school health teams is not widely detailed in the literature, it typically includes nurses, doctors, and psychologists^(3,4,12). In particular, school nurses, who require specialized training and continuous professional development, play an essential role in daily support for students’ health needs^(2,3,13).

Digital transformation has been a crucial ally in this process, facilitating access to health information and training, and exploring new tools that make education more inclusive and adapted to the digital age^(14,15). The COVID-19 pandemic further reinforced this importance, accelerating the incorporation of technologies to promote learning^(15,16).

Most interventions considered essential in school health services concern health promotion and health education, compared to those related to the inclusion of CSHCN⁽¹⁷⁾. In addition, one of the most frequently reported challenges for school health services is the lack of training and continuing professional development opportunities⁽⁴⁾.

Training programs are structured sets of interrelated activities designed to develop knowledge, attitudes, and skills in specific areas⁽¹⁸⁾. These programs include educational interventions, in this case mediated by technologies, that foster learning and capacity building, enhancing participants’ performance and competencies.

In this study, the term technology refers to educational technology as the application of technological tools and resources to improve teaching and learning. It encompasses the use of various digital tools, software and devices to improve educational outcomes and experiences⁽¹⁹⁾.

The literature is scattered in relation to the pedagogical process and the conceptual framework of training, specifically regarding technology-mediated training. The main characteristics of these programs and the link between learning outcomes and the assessment tools used are also not well characterized.

This scoping review aimed to map technology-mediated training programs for school health teams, focusing on special health care needs in the school setting. The specific review questions were: What pedagogical models, theories, or conceptual principles have been used to design these training programs? Do these training programs address specific health conditions? What is the organization of the training process (learning objectives, program, timetable, modality, type of technology, and participants) and the teaching and learning strategies? What learning outcomes were assessed, and what instruments were used to assess the desired learning objectives?

The specific reason for choosing a scoping review is because it aims to map the existing evidence underlying a research area, identify gaps in the existing evidence, and build a precursor exercise that justifies and informs the conduct of a systematic literature review⁽²⁰⁾.

METHOD

A search conducted on September 13, 2021, in MEDLINE (PubMed) and the JBI Evidence Synthesis, revealed that no literature review is available or being developed on technology-mediated training programs for school health teams focused on special health needs. Thus, opportunities for technology-mediated training for school health teams should be identified for them to develop skills in their practice and find gaps for future research in the field of school nursing.

Design of Study

We followed the JBI methodology for scoping reviews, and the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist^(21,22) associated with the PRISMA 2020 Flowchart⁽²³⁾. The quality of the studies was not particularly assessed as this is a scoping review. The review protocol was carried out and registered in the Open Science Framework (OSF) with the review title and DOI 10.17605/OSF.IO/53Z89.

Data Sources and Research Strategy

The review question was formulated according to the PCC framework, with Population (P) being school health teams, Concept (C) focusing on technology-mediated training programs addressing special health care needs, and Context (C) encompassing any location where training can take place. The types of evidence sources included primary studies utilizing qualitative, quantitative, or mixed methods, as well as systematic reviews. The review was restricted to studies published in Portuguese, English, or Spanish from 2000.

The review included studies involving healthcare professionals from school health teams, particularly those qualified in health promotion and supporting CSHCN. It also included technology-mediated training programs aimed at enhancing the skills of school health teams in managing CSHCN and chronic health conditions, namely educational interventions, such as sessions, seminars, lectures, and continuous professional development, specifically designed for healthcare professionals in the school context. The context included any training environment, and the selected chronological period reflects the technological advancements of the early 21st century, highlighting the evolution of technology in education and training. Studies targeting non-healthcare professionals, such as teachers, and studies lacking clear identification of training programs were excluded.

A three-step search strategy was used. First, an initial search on MEDLINE (via PubMed), CINAHL (via EBSCO) using general keywords, such as “School Health” AND technolog* AND (lifelong or Continuing) were conducted. The results of this initial search were analyzed to identify other keywords and index terms to be used in final search strategy. These terms were organized in a logic grid that was the basis to conduct the second phase of the search. In the second phase, five databases were searched: MEDLINE (via PubMed), CINAHL (via EBSCO), SCOPUS, Psychology and Behavioral Sciences Collection (via EBSCO) and LILACS, applying the keywords and indexed terms identified previously and adapted for each database included.

The search of grey literature was conducted in the Repositório Científico de Acesso Aberto de Portugal [Open Access Scientific Repository of Portugal] (RCAAP), Catálogo de Teses & Dissertações [Theses and Dissertation Catalog] (CAPES), and Mednar. Additionally, three official and governmental websites dealing with the topic, specifically the Centers for Disease Control and Prevention (CDC) - Health School, the National Association of School Nurses (NASN), and the New Zealand School Nurses (NZ+SN) were searched. In the third phase, the reference list of the selected studies for additional studies was searched, as well as the gray literature. The full search strategy for each database and sources of grey literature is detailed in Chart 1.

Chart 1. Scoping review search strategies – Coimbra, Portugal, 2021–2022.

MEDLINE via PubMed: Searched on November 11, 2021
ID	Search strategy
#19	Search: (((“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])) AND ((Continuing[Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh]))) AND (((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh])) Filters: English, Portuguese, Spanish	79
#18	Search: (((“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])) AND ((Continuing[Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh]))) AND (((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh])) Filters: English, Portuguese	78
#17	Search: (((“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])) AND ((Continuing[Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh]))) AND (((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh])) Filters: English	78
#16	Search: (((“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])) AND ((Continuing[Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh]))) AND (((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh])) Filters: Spanish	1
#15	Search: (((“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])) AND ((Continuing[Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh]))) AND (((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh]))	79
#14	Search: ((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh])	2,493,775
#13	Search: “Digital Technology”[Mesh] Sort by: Most Recent	349
#12	Search: “Educational Technology”[Mesh] Sort by: Most Recent	112,531
#11	Search: “Computer-Assisted Instruction”[Mesh] Sort by: Most Recent	12,258
#10	Search: “Computer Simulation”[Mesh] Sort by: Most Recent	265,374
#9	Search: “Computer User Training”[Mesh] Sort by: Most Recent	2,041
#8	Search: “Education, Distance”[Mesh] Sort by: Most Recent	5,550
#7	Search: Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]	2,205,126
#6	Search: (Continuing [Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh])	139,978
#5	Search: (“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])	28,076
#4	Search: “Education, Continuing”[Mesh] Sort by: Most Recent	62,175
#3	Search: Continuing [Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]	91,552
#2	Search: “School Health Services”[Mesh] Sort by: Most Recent	23,930
#1	Search: “school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]	11,013
SCOPUS: Searched on November 11, 2021
Search strategy
( TITLE-ABS-KEY ( “school nurses” OR “School Health” OR “School-Based Health” OR “School Based Services” OR “School Based Service” OR “School-Based Service” OR “School-Based Services” OR “School Based Health” OR “school nurse” ) AND TITLE-ABS-KEY ( continuing OR “lifelong learning” OR “professional development” ) AND TITLE-ABS-KEY ( technolog* OR computer* OR online OR smartphone* OR electronic* OR virtual OR augmented OR mobile OR gamification OR platform* OR internet OR e-learn* OR mooc OR distance OR hybrid OR digital OR blend* ) )		118
Psychology & Behavioral Sciences Collection via EBSCOhost: Searched on November 11, 2021
Search strategy
S1 AND S2 AND S3		4
TI ( Technolog* OR Computer* OR Online OR Smartphone* OR Electronic* OR Virtual OR Augmented OR Mobile OR Gamification OR Platform* OR Internet OR e-learn* OR MOOC OR Distance OR Hybrid OR Digital OR Blend* ) OR AB ( Technolog* OR Computer* OR Online OR Smartphone* OR Electronic* OR Virtual OR Augmented OR Mobile OR Gamification OR Platform* OR Internet OR e-learn* OR MOOC OR Distance OR Hybrid OR Digital OR Blend* )		93,277
TI (Continuing OR “lifelong learning” OR “professional development”) OR AB (Continuing OR “lifelong learning” OR “professional development”)		8,284
TI ( “school nurses” OR “School Health” OR “School-Based Health” OR “School Based Services” OR “School Based Service” OR “School-Based Service” OR “School-Based Services” OR “School Based Health” OR “school nurse” ) OR AB ( “school nurses” OR “School Health” OR “School-Based Health” OR “School Based Services” OR “School Based Service” OR “School-Based Service” OR “School-Based Services” OR “School Based Health” OR “school nurse” )		1,386
CHINAL Complete via EBSCOhost: Searched on November 6, 2021
Search strategy
S9 AND S18		72
S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17		529,504
(MH “Digital Technology”)		520
(MH “Educational Technology”)		2,270
(MH “Programmed Instruction+”)		8,693
(MH “Gamification”)		108
(MH “Computer Simulation+”)		24,615
(MH “Computer User Training”)		790
(MH “Education, Non-Traditional+”)		12,192
TI ( Technolog* OR Computer* OR Online OR Smartphone* OR Electronic* OR Virtual OR Augmented OR Mobile OR Gamification OR Platform* OR Internet OR e-learn* OR MOOC OR Distance OR Hybrid OR Digital OR Blend* ) OR AB ( Technolog* OR Computer* OR Online OR Smartphone* OR Electronic* OR Virtual OR Augmented OR Mobile OR Gamification OR Platform* OR Internet OR e-learn* OR MOOC OR Distance OR Hybrid OR Digital OR Blend* )		506,762
S5 AND S8		572
S6 OR S7		77,866
(MH “Education, Continuing+”)		36,102
TI (Continuing OR “lifelong learning” OR “professional development”) OR AB (Continuing OR “lifelong learning” OR “professional development”)		50,779
S1 OR S2 OR S3 OR S4		28,980
(MH “School Health Services+”)		24,084
(MH “School Health”)		4,067
(MH “National Association of School Nurses”)		557
TI ( “school nurses” OR “School Health” OR “School-Based Health” OR “School Based Services” OR “School Based Service” OR “School-Based Service” OR “School-Based Services” OR “School Based Health” OR “school nurse” ) OR AB ( “school nurses” OR “School Health” OR “School-Based Health” OR “School Based Services” OR “School Based Service” OR “School-Based Service” OR “School-Based Services” OR “School Based Health” OR “school nurse” )		7,426
LILACS: Searched on March 21, 2022
ID	Search strategy
	(“school health”) AND (continuing)	25
RCAAP: Searched on March 21, 2022
ID	Search strategy
	“school health”	52
CAPES: Searched on March 21, 2022
ID	Search strategy
	“school health” AND continuing	23
Mednar: Searched on March 29, 2022
ID	Search strategy
	“school health” AND continuing AND technology	733

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Duplicates were eliminated using the software Mendeley Reference Manager. The software Rayyan Qatar Computing Research Institute (Rayyan QCRI) was used to assist in archiving, organizing, and selecting the articles for title and abstract.

Study Selection and Data Extraction

The study selection process was conducted independently in two stages by two reviewers, with a third reviewer resolving conflicts. The first stage involved reviewing titles and abstracts to exclude articles that did not meet the inclusion criteria. If the eligibility of a study was unclear, it was still advanced to the second stage for further evaluation. In this second stage, all eligible studies were retrieved in full, thoroughly read, and analyzed. Data were independently extracted by two reviewers. In case of disagreement, a third reviewer intervened. Extracted data included details about the authors, year, country, study type, and sample characteristics, data on training programs, including covering participants (number and type), conceptual and pedagogical framework, objectives, curriculum, schedule, modality, technologies used, teaching strategies, and assessment. Data were organized in a table developed by the authors. The data extraction form was pre-tested, and inconsistencies were discussed with senior researchers to reach a consensus.

Ethical Aspects

No ethical review was required since the study used publicly available secondary data, and all copyright regulations for the cited research were observed.

RESULTS

From a total of 1,106 potentially relevant articles initially identified, 111 duplicates, as well as 966 articles in the title and abstract screening, and 21 in the full-text review were excluded. Eight articles met the established inclusion criteria and were selected for data extraction. Figure 1 illustrates the study selection process, with documented reasons for exclusions.

The findings of the review were synthesized narratively. The main characteristics of the studies are summarized in Chart 2, followed by an analysis that describes the relationship between these characteristics and the objectives and questions of the review. The categories and characteristics analyzed include: the characterization of the studies and the conceptual framework of the training programs; the organization of the training process (objectives, program, schedule, modality, and technology used); the teaching and learning strategies; and the evaluation methods.

Chart 2. Detailed descriptive characteristics of the included studies (n = 8) – Lisboa, Portugal, 2023.

Citation, country	Design	Objective	Population sample	Guides/Framework	Training programs characteristics	Teaching and learning strategies	Assessment practices
1 Jean A. Bachman and Kuei-Hsiang Hsueh, 2008, United States⁽²⁴⁾.	Program evaluation post-test intervention.	Develop and evaluate an online program for school nurses on diabetes care management for children in school.	N = 19 school nurses.	“Diabetes Management in the School Setting”⁽²⁵⁾. NIH/CDC’s “Helping the Student with Diabetes Succeed”⁽²⁶⁾. Developed based on Rogers’ diffusion of innovations theory⁽²⁷⁾.	3 lessons over 2-3 weeks on Blackboard® covering childhood diabetes, school management, insulin pumps, and the school nurse’s role.	Engaged with online PowerPoint® presentations. Participated in three discussion boards. Posted written responses. Moderated by faculty.	Includes formative evaluation, learning objectives assessment, and feedback on content, teaching, and training format preferences.
2 Elgie et al., 2010, United States⁽²⁸⁾.	Experimental after-only posttest design.	To evaluate the effectiveness of a computer-assisted emergency preparedness course for school nurses.	N = 42 school nurses.	Situated-cognitive learning theory⁽²⁹⁾.	Online course on computer-assisted instruction; evaluates scene safety and stabilization skills.	15 online emergency preparedness modules focusing on decision-making with immediate feedback and skills demonstrations.	Knowledge and skills were assessed through an exam, confidence survey, and OMES, with videos evaluated by physicians unaware of the group.
3 Heidi Putman-Casdorph and Susan Pinto 2011, United States⁽³⁰⁾.	A quasi-experimental design with pre-and post-test intervention evaluation.	Develop and evaluate distance learning for continuing asthma education for school nurses in West Virginia.	N= 20 school nurses.	Basic asthma information following the National Institutes of Health National Asthma Education Prevention program. Asthma Care Guidelines⁽³¹⁾.	Pilot Asthma Education Module: Delivered via web conferencing technology (Wimba Live Classroom). Pathophysiology of asthma, medications, and treatment devices.	Group 1: Received a recorded asthma education module. Group 2: Received the module live with an online instructor. Nurses earned continuing education units upon completion.	Asthma knowledge and confidence were assessed using the SHPQ, with intervention groups completing it pre- and post-module, and the control group separately.
4 Cicutto et al., 2016, United States⁽³²⁾.	A modified Delphi and Program evaluation with pre-and post-test intervention.	To develop and implement a competency-based framework for a continuing education curriculum for school nurses.	N=40 school nurses.	The National Asthma Educator Certification Board’s Certified Asthma Educator competencies⁽³³⁾ and the Healthy Learner Model(34,35).	The hybrid model combined an online asthma program with a local workshop, featuring 12 self-paced units on the Asthma and Allergy Foundation’s website. Trainees completed training at their own pace.	School nurses completed the online Asthma Management course and attended local workshops on asthma care, featuring case studies and hands-on inhaler assessments.	Knowledge, self-confidence, and inhaler skills were assessed, with self-efficacy rated from 0 to 4. The online course included a quiz and evaluated satisfaction.
5 Lisa Blackmon-Jones, 2016, United States⁽³⁶⁾.	Program evaluation with pre-and post-test intervention.	To share the findings of implementing a standardized, blended approach to school nurse orientation.	N=20 school nurses.	According to Patricia Benner’s theoretical framework⁽³⁷⁾.	The blended orientation covered Diabetes, Asthma, Anaphylaxis, Catheterizations, Tube feedings, Seizures, Ventilators, Tracheostomy care, and mental health.	The program features strategies like traditional classes and skills labs, with state-mandated screening certifications completed at the start of the year for effective follow-up.	Participants noted improvements in training and mentorship. Data collection included self-assessments, and a nurse specialist assessed proficiency after the orientation.
6 Rhodes et al., 2019, United States⁽³⁸⁾.	Program evaluation with pre-and post-test intervention.	To assess the effectiveness of a rapid e-learning module for school nurse professional development in school-based diabetes management.	N = 1127 School nurses.	The latest school-based diabetes care guidelines from the National Diabetes Education Program were designed using the ICARE framework for e-learning in nursing education⁽³⁹⁾.	The rapid e-learning module addressed diabetes management in schools, including updates on equipment, dietary practices, psychological impacts, type 2 management, and three staff training levels.	The email included a link, cover letter, rapid e-learning module with a pre-post test, and a certificate. A reminder encouraged summer completion, and the Extend phase provided links to credible medical resources.	Knowledge of diabetes management was assessed with multiple-choice and true-false questions from the e-learning module, which included “how-to” sections and understanding checks.
7 Shimasaki et al., 2019, United States⁽⁴⁰⁾.	Program evaluation with pre-and post-test intervention.	Evaluate the impact of the “School Nurses Managing Diabetes Care” series on Colorado school nurses’ collaboration and self-efficacy.	N = 60 School nurses.	The student-centered Framework for 21st Century School Nursing Practice™ highlights student-focused nursing, supported by key professional principles⁽⁴¹⁾ and intensive diabetes management guidelines⁽⁴²⁾.	The program featured telehealth sessions on diabetes care, with a 4-week ECHO series of two cohorts, each having four weekly 1-hour sessions.	Sessions support peer learning through case presentations, brief didactic talks, and are moderated by a facilitator, allowing live or chat questions.	Sessions promote peer learning, with self-efficacy and satisfaction ratings, open-ended feedback on practice changes and barriers, and an online quiz via Qualtrics.
8 American Diabetes Association (ADA) 2021, United States⁽⁴³⁾.	Training Website.	Prepare and educate school staff to provide needed care to students with diabetes.		The updated guide online helping the student with diabetes succeed: a guide for school personnel.	The website offers self-paced resources for school staff on diabetes care, including guidance, workshops, and tools.	The ADA School Diabetes Care Tasks is a 19-module training program for school nurses to train non-clinical staff in diabetes care.	A post-test is available at the end of each module from the program School Diabetes Care Tasks: What Key Personnel Need to Know.

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The studies reviewed span from 2008 to 2021, with most conducted post-2016 (n = 5) and all in the United States of America (USA). Most applied a quantitative approach (n = 6) for evaluating the effectiveness of the training programs^{(24,28,30,36,38,40)} while one used a mixed-methods approach⁽³²⁾. Being a program from the American Diabetes Association website, the article does not specify the study type⁽⁴³⁾.

Seven training programs addressed chronic health conditions. Four focused on diabetes^{(24,38,40,43)}, two on asthma^(30,32) , one covered various chronic conditions, and one, emergency preparedness^(28,36). All studies were centered on school health nurses and adhered to theoretical-methodological frameworks, including clinical practice guides^{(24,30,32,38,40,43)}, theoretical references from nursing and other disciplines^{(24,28,32,36,40)}, and innovative educational models using technology^(24,38).

The overall objectives of collected studies focused mostly on evaluating effectiveness and developing technology-supported training^{(24,28,30,32,38,40)}. Specific objectives targeted diabetes management^(24,38,40), asthma management⁽³²⁾ and other chronic conditions⁽³⁶⁾, while some studies lacked explicit objectives^(28,30,43).

The program structure included topics such as diabetes control^{(24,38,40,43)}, emergency procedures⁽²⁸⁾, asthma control ^(30,32), and procedures for chronic conditions⁽³⁶⁾. Programs were categorized into e-learning and blended learning formats, with most of them being delivered asynchronously^{(24,30,38,43)}, with synchronous sessions offered via videoconferencing^(28,30,40). All of them were organized into thematic modules with varying durations. Predominantly, short training activities were identified, such as one day of in-service training, sessions lasting two to ten hours, and four weekly sessions of one hour each^{(28,30,32,40)}. Learning took place over an eight-month period within a single program⁽³⁶⁾. One study did not specify the time required to complete the activities but recommended completion during the summer⁽³⁸⁾. The ADA website’s content was accessible unlimited number of times, allowing learners to set their own learning pace.

Educational strategies relied on technology, such as learning management systems^(24,30,32), personalized email resources⁽³⁸⁾, and collaborative online tools⁽²⁴⁾. Case-based learning was emphasized through both asynchronous and synchronous sessions⁽⁴⁰⁾. Audiovisual scenarios and immediate feedback were utilized to enhance learning experiences⁽²⁸⁾. ADA’s website offered a range of resources, including virtual workshops, case studies, and competency checklists for school nurses⁽⁴³⁾.

Blended learning formats combined online modules with face-to-face problem-based workshops⁽³²⁾. Innovative strategies, such as skills labs and computer-based documentation training were also used⁽³⁶⁾. Two studies controlled the number of participants to ensure quality^(24,40).

The evaluation focused on self-efficacy, confidence, knowledge acquisition, and skills development^{(24,28,30,32,36,38,40)}. Program quality was assessed in three studies^(24,36,40), with summative assessments often applied. One study highlighted formative assessments⁽²⁴⁾. Various evaluation tools were employed, such as Likert scales, true-false questions, and visual analog scales. Summative assessments included filmed simulated scenarios and case management ^(28,36).

DISCUSSION

This study showed essential elements of technology-mediated training programs for school health professionals. The objectives and research questions are highlighted here. Although our research was global and covered three languages, all studies identified were conducted in the USA and focused on school nurses. This is likely related to the distinct role these professionals play in the American context. In the USA, school nurses are essential for promoting student health, well-being, and educational success, as they are often the only healthcare providers within schools^(3,13,44,45). The NASN, established in 1968, reinforces this structured approach by providing guidelines such as the 21^st Century School Nursing Practice™ model and advocating for the full-time presence of school nurses^(41,46). With approximately 132,300 school nurses in the USA⁽⁴⁷⁾, ongoing investment in their professional development is supported by national assessment systems, such as the National Survey of Children’s Health⁽⁴⁸⁾, which inform school health policies. In contrast, Europe shows a significant gap in research on this topic, despite the recommendations from the European Network of Health Promoting Schools, which emphasizes the urgent need for further investigation and the implementation of health integration policies in schools⁽⁴⁹⁾. Furthermore, in other regions of the world, such as Latin America, Africa, and parts of Asia, structured training programs in this field of school health have also not been identified.

This scoping review included studies published in Portuguese, English, and Spanish, intending to capture a comprehensive view of global practices. However, despite this inclusive approach, all included studies originated from the United States, which demonstrates a significant geographical bias in the literature. This limitation reflects the overrepresentation of English-speaking contexts and highlights the lack of studies from regions such as Latin America, which share linguistic similarities but are underrepresented in the global research corpus.

Latin America presents a unique opportunity for research due to its high ethnic and cultural diversity and distinct social determinants of health⁽⁵⁰⁾. Research from this region has been sparse, not only in the domain of school health training but also across other public health domains⁽⁵¹⁾. Addressing these gaps requires a conscious effort to include diverse voices and research outputs, thereby promoting a more comprehensive understanding of global health challenges and solutions. Expanding the geographic scope of research is crucial, not only to ensure inclusivity but also to tailor interventions that are culturally and contextually relevant.

Data revealed a significant gap in the pedagogical structures of technology-mediated training programs. Although programs integrate technology for remote learning, most do not align with established pedagogical models, often converting traditional practices into virtual formats⁽⁵²⁾. Only two programs incorporate pedagogical models: the ICARE model - Introduction, Connect, Apply, Reflect, and Extend⁽³⁹⁾ and Rogers’ Diffusion of Innovations model⁽²⁷⁾, highlighting the importance of grounding technology-mediated programs in sound pedagogical principles. The use of technology with educational intent is essential, requiring pedagogical support in the structures, actors, and teaching strategies⁽⁵³⁾. In an e-activities framework, the design of online activities with intentional pedagogical strategies is crucial to promote engagement and active participation, going beyond the simple transfer of traditional practices to digital formats⁽⁵⁴⁾. Similarly, effective online education requires structuring courses based on pedagogical theories that facilitate meaningful interactions⁽⁵⁵⁾, such as the Community of Inquiry model⁽⁵⁶⁾, ensuring that technology-enhanced programs are more than just innovative - they are pedagogically sound. Online educational programs are seen as innovative and complementary approaches⁽⁵⁷⁾, and blended learning, in particular, has the potential to increase the effectiveness and efficiency of educational activities⁽⁵⁸⁾.

These programs were strongly influenced by a hands-on approach, incorporating guidelines based on recommended directives. It was also observed that the influence of nursing theoretical models, such as the student-centered framework of the 21st Century School Nursing Practice™⁽⁴⁷⁾ and Benner’s model⁽³⁷⁾, can be crucial for structuring nursing practice and enriching the educational experience⁽⁵⁹⁾.

The definition of CSHCN is not limited to the presence of a clinical diagnosis but rather encompasses the consequences that a condition can generate across various domains, making the concept broader and more inclusive⁽⁶⁰⁾. However, the programs identified in this research review tend to focus on specific health conditions. The analyzed programs tend to prioritize conditions highlighted in the epidemiological profile of children requiring urgent interventions, such as diabetes and asthma, likely due to the high risk of serious or fatal outcomes^(61–63).

Training programs were fundamental in all collected studies, promoting educational interventions that provided nurses with the knowledge, skills, and confidence needed to deliver quality care. These findings confirm the positive impact of continuous education on maintaining high standards of nursing care⁽⁶⁴⁾. Ongoing training is essential for the effective management of special health needs in the school environment, and this should be adapted to the specific needs of nurses⁽⁶⁵⁾.

The teaching strategies applied in the studies ranged from PowerPoint modules to interactive discussion forums, promoting both autonomous and collaborative learning. The need for environments that facilitate interaction among nurses is emphasized, as well as the flexibility provided by digital technologies. Additionally, e-learning has emerged as an effective alternative for continuing education in nursing, demonstrating positive results in terms of satisfaction, flexibility, and content relevance^(45,66,67).

All the analyzed studies emphasized the importance of detailing how the assessment of knowledge, skill development, self-efficacy, and professional confidence of nurses occur, integrating assessment practices into training planning. Competency-based training aims to improve population’s health outcomes⁽⁶⁸⁾. The results of this review indicate that such programs can strengthen the self-efficacy and confidence of school nurses⁽⁶⁹⁾. Self-efficacy influences the perception of the ability to change behaviors, which is crucial for the acquisition of clinical skills⁽⁷⁰⁾. Although it was not mentioned, Kirkpatrick evaluation model is widely used to measure training effectiveness through four levels⁽⁷¹⁾.

The results show that the evaluations conducted predominantly focused on the summative component, neglecting formative assessment, which is crucial for monitoring the learning process during the design and development of training. Furthermore, the mere incorporation of technologies into assessment does not ensure an effective transformation of evaluation methods⁽⁷²⁾. This underscores the urgency for adaptations in assessment in response to changes in educational environments resulting from the migration to digital spaces⁽⁷³⁾. It is also essential to explore new paradigms of assessment and self-assessment in technology-mediated training models, recognizing and valuing the diversity of digital assessment methods. To this end, it is recommended to integrate assessment tasks and activities that simulate real-life situations⁽⁷²⁾. In this context, the implementation of continuous assessment strengthens the structure of the evaluation model, emphasizing its formative function and promoting the development of learners by placing them at the center of the educational process.

This review had limitations, such as only searching for studies in English, Portuguese, or Spanish. In spite of these limitations, it identified a knowledge gap, providing insights into future research and suggesting an approach for developing technology-mediated training programs focusing on special health needs in a school context.

CONCLUSION

This scoping review revealed significant methodological and practical implications for the development of training programs aimed at school teams, with a focus on special health needs. The use of multiple digital resources enriches the training, fostering both individual and collaborative learning. Looking ahead, it is crucial to address the lack of a solid pedagogical framework for digital environments, the need for further research into the various domains associated with special health needs, particularly those involving support from interdisciplinary school teams, and for training adapted to digital formats, incorporating consistent and suitable formative evaluation tools.

Funding Statement

This study was financed in part by the Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brasil (CNPq) process: 401923/2024-0 (spanish language version).

Footnotes

Financial support

This study was financed in part by the Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brasil (CNPq) process: 401923/2024-0 (spanish language version).

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Rev Esc Enferm USP. 2025 May 9;59:e20240328. [Article in Spanish] doi: 10.1590/1980-220X-REEUSP-2024-0328es

Programas de capacitación mediados por tecnología para equipos de salud escolar sobre necesidades especiales de atención de salud: una revisión del alcance

RESUMEN

Objetivo:

Mapear programas de formación mediados por tecnología para equipos de salud escolar que aborden necesidades especiales de salud en el entorno escolar e identificar sus características.

Método:

La revisión siguió la metodología del JBI. Se buscaron literatura publicada y gris en ocho bases de datos. Se incluyeron estudios publicados en portugués, inglés o español desde el año 2000 para identificar los programas de formación emergentes.

Resultados:

De los 1.106 estudios identificados, 29 fueron revisados en su totalidad y ocho fueron incluidos en el análisis final. Todos los estudios fueron realizados en los Estados Unidos de América. Los temas del programa incluyeron condiciones de salud crónicas como diabetes, asma, procedimientos, así como situaciones de emergencia, todos dirigidos a enfermeros escolares y basados en un marco conceptual o pedagógico. Los programas incluyeron módulos temáticos de diversa duración y ofrecieron formación en línea e híbrida a través de diversos recursos educativos digitales.

Conclusiones:

Los programas se centraron en las condiciones de salud crónicas y evaluaron el conocimiento, el desarrollo de habilidades, la autoeficacia y la confianza de los profesionales; pocos estudios proporcionaron una exploración detallada de los modelos pedagógicos subyacentes y no utilizaron una evaluación formativa.

DESCRIPTORES: Servicios de Salud Escolar, Salud Infantil, Capacitación Profesional, Tecnología Educacional, Servicios de Enfermería Escolar

INTRODUCCIÓN

La escuela desempeña un papel fundamental en la vida de los niños y los jóvenes. Además de promover la educación, también es responsable de promover la salud y el bienestar, ya que los alumnos pasan gran parte de su tiempo en el entorno escolar^(1–4). La Academia Americana de Pediatría (AAP) define a los niños y jóvenes con necesidades especiales de atención sanitaria (CSHCN en la sigla en inglés) como aquellos que padecen o corren el riesgo de padecer enfermedades crónicas que requieren atención sanitaria y servicios especializados⁽⁵⁾. Estos niños se enfrentan a desventajas en el entorno escolar, con un mayor riesgo de exclusión de las actividades educativas y sociales, lo que puede repercutir negativamente en su rendimiento académico^{(6, 7, 8, 9)}. Por lo tanto, la integración de la salud y la educación es esencial para crear un ciclo de salud universal, que garantice el acceso a una educación inclusiva y de calidad para todos los niños, independientemente de sus condiciones de salud^(10,11).

Según la Organización Mundial de la Salud (OMS), los servicios de salud escolar son prestados por profesionales de la salud dentro de las escuelas o en colaboración con servicios externos⁽⁴⁾. Aunque la composición de los equipos de salud escolar no aparece muy detallada en la bibliografía, suele incluir enfermeras, médicos y psicólogos^(3,4,12). En particular, las enfermeras escolares, que requieren formación especializada y desarrollo profesional continuo, desempeñan un papel esencial en el apoyo diario a las necesidades de salud de los estudiantes^(2,3,13).

La transformación digital ha sido un aliado crucial en este proceso, facilitando el acceso a la información y formación en salud, y explorando nuevas herramientas que hagan la educación más inclusiva y adaptada a la era digital^(14,15). La pandemia de COVID-19 reforzó aún más esta importancia, acelerando la incorporación de tecnologías para promover el aprendizaje^(15,16).

La mayoría de las intervenciones consideradas esenciales en los servicios de salud escolar se refieren a la promoción de la salud y la educación sanitaria, frente a las relacionadas con la inclusión de los CSHCN⁽¹⁷⁾. Además, uno de los desafíos más frecuentemente reportados para los servicios de salud escolar es la falta de oportunidades de capacitación y desarrollo profesional continuo⁽⁴⁾.

Los programas de capacitación son conjuntos estructurados de actividades interrelacionadas diseñadas para desarrollar conocimientos, actitudes y habilidades en áreas específicas⁽¹⁸⁾. Estos programas incluyen intervenciones educativas, en este caso mediadas por tecnologías, que fomentan el aprendizaje y el desarrollo de capacidades, mejorando el rendimiento y las competencias de los participantes.

En este estudio, el término tecnología se refiere a la tecnología educativa como la aplicación de herramientas y recursos tecnológicos para mejorar la enseñanza y el aprendizaje. Abarca el uso de diversas herramientas digitales, software y dispositivos para mejorar los resultados y las experiencias educativas⁽¹⁹⁾.

La literatura es escasa en relación con el proceso pedagógico y el marco conceptual de la formación, específicamente en lo que se refiere a la formación mediada por tecnología. Tampoco están bien explicitadas las principales características de estos programas ni la relación entre los resultados del aprendizaje y las herramientas de evaluación utilizadas.

Esta revisión de alcance tuvo como objetivo mapear los programas de formación mediados por tecnología para los equipos de salud escolar, centrándose en las necesidades especiales de atención sanitaria en el ámbito escolar. Las preguntas específicas de la revisión fueron: ¿Qué modelos pedagógicos, teorías o principios conceptuales se han utilizado para diseñar estos programas de formación? ¿Abordan estos programas de formación condiciones sanitarias específicas? ¿Cuál es la organización del proceso de formación (objetivos de aprendizaje, programa, calendario, modalidad, tipo de tecnología y participantes) y las estrategias de enseñanza y aprendizaje? ¿Qué resultados de aprendizaje se evaluaron y qué instrumentos se utilizaron para evaluar los objetivos de aprendizaje deseados?

La razón específica para elegir una revisión de alcance es que su objetivo es mapear la evidencia existente subyacente a un área de investigación, identificar lagunas en la evidencia existente, y construir un ejercicio precursor que justifique e informe la realización de una revisión sistemática de la literatura científica⁽²⁰⁾.

MÉTODO

Una búsqueda realizada el 13 de septiembre de 2021 en MEDLINE (PubMed) y en el JBI Evidence Synthesis, reveló que no hay ninguna revisión bibliográfica disponible o en desarrollo sobre programas de formación mediados por tecnología para equipos de salud escolar centrados en necesidades especiales de salud. Por lo tanto, se deben identificar oportunidades de formación mediada por tecnología para los equipos de salud escolar para que desarrollen habilidades en su práctica y encontrar lagunas para futuras investigaciones en el campo de la enfermería escolar.

Diseño del Estudio

Se siguió la metodología del JBI para las revisiones de alcance, y las recomendaciones de la Lista de verificación de los Elementos de Información Preferidos para Revisiones Sistemáticas y Metaanálisis (PRISMA-ScR)^(21,22)asociada al Diagrama de flujo PRISMA 2020⁽²³⁾. No se evaluó especialmente la calidad de los estudios por tratarse de una revisión de alcance. El protocolo de revisión se llevó a cabo y se registró en el Open Science Framework (OSF) con el título de la revisión y el DOI 10.17605/OSF.IO/53Z89.

Fuentes de Datos y Estrategia de Investigación

La pregunta de revisión se formuló de acuerdo con el marco PCC, siendo la Población (P) los equipos de salud escolares, el Concepto (C) se centró en los programas de formación mediados por tecnología que abordan las necesidades especiales de atención sanitaria, y el Contexto (C) abarcó cualquier lugar donde pueda tener lugar la formación. Los tipos de fuentes de evidencia incluían estudios primarios que utilizaban métodos cualitativos, cuantitativos o mixtos, así como revisiones sistemáticas. La revisión se restringió a estudios publicados en portugués, inglés o español a partir del año 2000.

La revisión incluyó estudios que involucraron a profesionales de la salud de equipos de salud escolar, particularmente aquellos calificados en promoción de la salud y apoyo a CSHCN. También incluyó programas de capacitación mediados por tecnología destinados a mejorar las habilidades de los equipos de salud escolar en el manejo de CSHCN y condiciones crónicas de salud, a saber, intervenciones educativas, tales como sesiones, seminarios, conferencias y desarrollo profesional continuo, diseñados específicamente para profesionales de la salud en el contexto escolar. El contexto incluía cualquier entorno de formación, y el periodo cronológico seleccionado refleja los avances tecnológicos de principios del siglo XXI, destacando la evolución de la tecnología en la educación y la formación. Se excluyeron los estudios dirigidos a profesionales no sanitarios, como profesores, y los estudios que carecían de una identificación clara de los programas de formación.

Se utilizó una estrategia de búsqueda en tres etapas. En primer lugar, se realizó una búsqueda inicial en MEDLINE (a través de PubMed), CINAHL (a través de EBSCO) utilizando palabras clave generales, como «School Health» AND technolog* AND (lifelong or Continuing). Los resultados de esta búsqueda inicial se analizaron para identificar otras palabras clave y términos de índice que se utilizarían en la estrategia de búsqueda final. Estos términos se organizaron en una cuadrícula lógica que sirvió de base para realizar la segunda fase de la búsqueda. En la segunda fase, se realizaron búsquedas en cinco bases de datos: MEDLINE (vía PubMed), CINAHL (vía EBSCO), SCOPUS, Psychology and Behavioral Sciences Collection (vía EBSCO) y LILACS, aplicando las palabras clave y términos indexados identificados previamente y adaptados para cada base de datos incluida.

La búsqueda de literatura gris se realizó en el Repositório Científico de Acesso Aberto de Portugal [Repositorio Científico de Acceso Abierto de Portugal] (RCAAP), Catálogo de Teses & Dissertações [Catálogo de Tesis y Disertaciones ] (CAPES) y Mednar. Además, se realizaron búsquedas en tres sitios web oficiales y gubernamentales relacionados con el tema, en concreto, los Centros para el Control y la Prevención de Enfermedades (CDC en la sigla en inglés) - Escuela de Salud, la Asociación Nacional de Enfermeras de Programas Escolares (NASN en la sigla en inglés) y las Enfermeras de Programas Escolares de Nueva Zelanda (NZ+SN en la sigla en inglés). En la tercera fase, se buscaron estudios adicionales en la lista de referencias de los estudios seleccionados, así como en la literatura gris. La estrategia de búsqueda completa para cada base de datos y las fuentes de literatura gris se detallan en el Cuadro 1.

Cuadro 1. Estrategias de búsqueda de la revisión de alcance – Coimbra, Portugal, 2021–2022.

MEDLINE vía PubMed: Búsqueda en 11 de noviembre de 2021
ID	Estrategia de búsqueda
#19	Search: (((“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])) AND ((Continuing[Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh]))) AND (((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh])) Filters: English, Portuguese, Spanish	79
#18	Search: (((“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])) AND ((Continuing[Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh]))) AND (((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh])) Filters: English, Portuguese	78
#17	Search: (((“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])) AND ((Continuing[Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh]))) AND (((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh])) Filters: English	78
#16	Search: (((“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])) AND ((Continuing[Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh]))) AND (((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh])) Filters: Spanish	1
#15	Search: (((“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])) AND ((Continuing[Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh]))) AND (((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh]))	79
#14	Search: ((((((Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]) OR (“Education, Distance”[Mesh])) OR (“Computer User Training”[Mesh])) OR (“Computer Simulation”[Mesh])) OR (“Computer-Assisted Instruction”[Mesh])) OR (“Educational Technology”[Mesh])) OR (“Digital Technology”[Mesh])	2,493,775
#13	Search: “Digital Technology”[Mesh] Sort by: Most Recent	349
#12	Search: “Educational Technology”[Mesh] Sort by: Most Recent	112,531
#11	Search: “Computer-Assisted Instruction”[Mesh] Sort by: Most Recent	12,258
#10	Search: “Computer Simulation”[Mesh] Sort by: Most Recent	265,374
#9	Search: “Computer User Training”[Mesh] Sort by: Most Recent	2,041
#8	Search: “Education, Distance”[Mesh] Sort by: Most Recent	5,550
#7	Search: Technolog[Title/Abstract] OR Computer[Title/Abstract] OR Online[Title/Abstract] OR Smartphone[Title/Abstract] OR Electronic[Title/Abstract] OR Virtual[Title/Abstract] OR Augmented[Title/Abstract] OR Mobile[Title/Abstract] OR Gamification[Title/Abstract] OR Platform[Title/Abstract] OR Internet[Title/Abstract] OR e-learn[Title/Abstract] OR MOOC[Title/Abstract] OR Distance[Title/Abstract] OR Hybrid[Title/Abstract] OR Digital[Title/Abstract] OR Blend*[Title/Abstract]	2,205,126
#6	Search: (Continuing [Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]) OR (“Education, Continuing”[Mesh])	139,978
#5	Search: (“school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]) OR (“School Health Services”[Mesh])	28,076
#4	Search: “Education, Continuing”[Mesh] Sort by: Most Recent	62,175
#3	Search: Continuing [Title/Abstract] OR “lifelong learning”[Title/Abstract] OR “professional development”[Title/Abstract]	91,552
#2	Search: “School Health Services”[Mesh] Sort by: Most Recent	23,930
#1	Search: “school nurses”[Title/Abstract] OR “School Health”[Title/Abstract] OR “School-Based Health”[Title/Abstract] OR “School Based Services”[Title/Abstract] OR “School Based Service”[Title/Abstract] OR “School-Based Service”[Title/Abstract] OR “School-Based Services”[Title/Abstract] OR “School Based Health”[Title/Abstract] OR “school nurse”[Title/Abstract]	11,013
SCOPUS: Búsqueda en 11 de noviembre de 2021
Estrategia de búsqueda
( TITLE-ABS-KEY ( “school nurses” OR “School Health” OR “School-Based Health” OR “School Based Services” OR “School Based Service” OR “School-Based Service” OR “School-Based Services” OR “School Based Health” OR “school nurse” ) AND TITLE-ABS-KEY ( continuing OR “lifelong learning” OR “professional development” ) AND TITLE-ABS-KEY ( technolog* OR computer* OR online OR smartphone* OR electronic* OR virtual OR augmented OR mobile OR gamification OR platform* OR internet OR e-learn* OR mooc OR distance OR hybrid OR digital OR blend* ) )		118
Psychology & Behavioral Sciences Collection via EBSCOhost: Búsqueda en 11 de noviembre de 2021
Estrategia de búsqueda
S1 AND S2 AND S3		4
TI ( Technolog* OR Computer* OR Online OR Smartphone* OR Electronic* OR Virtual OR Augmented OR Mobile OR Gamification OR Platform* OR Internet OR e-learn* OR MOOC OR Distance OR Hybrid OR Digital OR Blend* ) OR AB ( Technolog* OR Computer* OR Online OR Smartphone* OR Electronic* OR Virtual OR Augmented OR Mobile OR Gamification OR Platform* OR Internet OR e-learn* OR MOOC OR Distance OR Hybrid OR Digital OR Blend* )		93,277
TI (Continuing OR “lifelong learning” OR “professional development”) OR AB (Continuing OR “lifelong learning” OR “professional development”)		8,284
TI ( “school nurses” OR “School Health” OR “School-Based Health” OR “School Based Services” OR “School Based Service” OR “School-Based Service” OR “School-Based Services” OR “School Based Health” OR “school nurse” ) OR AB ( “school nurses” OR “School Health” OR “School-Based Health” OR “School Based Services” OR “School Based Service” OR “School-Based Service” OR “School-Based Services” OR “School Based Health” OR “school nurse” )		1,386
CHINAL Completada vía EBSCOhost: Búsqueda en el 6 de noviembre de 2021
Estrategia de búsqueda
S9 AND S18		72
S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17		529,504
(MH “Digital Technology”)		520
(MH “Educational Technology”)		2,270
(MH “Programmed Instruction+”)		8,693
(MH “Gamification”)		108
(MH “Computer Simulation+”)		24,615
(MH “Computer User Training”)		790
(MH “Education, Non-Traditional+”)		12,192
TI ( Technolog* OR Computer* OR Online OR Smartphone* OR Electronic* OR Virtual OR Augmented OR Mobile OR Gamification OR Platform* OR Internet OR e-learn* OR MOOC OR Distance OR Hybrid OR Digital OR Blend* ) OR AB ( Technolog* OR Computer* OR Online OR Smartphone* OR Electronic* OR Virtual OR Augmented OR Mobile OR Gamification OR Platform* OR Internet OR e-learn* OR MOOC OR Distance OR Hybrid OR Digital OR Blend* )		506,762
S5 AND S8		572
S6 OR S7		77,866
(MH “Education, Continuing+”)		36,102
TI (Continuing OR “lifelong learning” OR “professional development”) OR AB (Continuing OR “lifelong learning” OR “professional development”)		50,779
S1 OR S2 OR S3 OR S4		28,980
(MH “School Health Services+”)		24,084
(MH “School Health”)		4,067
(MH “National Association of School Nurses”)		557
TI ( “school nurses” OR “School Health” OR “School-Based Health” OR “School Based Services” OR “School Based Service” OR “School-Based Service” OR “School-Based Services” OR “School Based Health” OR “school nurse” ) OR AB ( “school nurses” OR “School Health” OR “School-Based Health” OR “School Based Services” OR “School Based Service” OR “School-Based Service” OR “School-Based Services” OR “School Based Health” OR “school nurse” )		7,426
LILACS: Búsqueda en 21 de marzo de 2022
ID	Estrategia de búsqueda
	(“school health”) AND (continuing)	25
RCAAP: Búsqueda en 21 de marzo de 2022
ID	Estrategia de búsqueda
	“school health”	52
CAPES: Búsqueda en 21 de marzo de 2022
ID	Estrategia de búsqueda
	“school health” AND continuing	23
Mednar: Búsqueda en 21 de marzo de 2022
ID	Estrategia de búsqueda
	“school health” AND continuing AND technology	733

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Los duplicados se eliminaron con el programa Mendeley Reference Manager. Se utilizó el software Rayyan Qatar Computing Research Institute (Rayyan QCRI) para ayudar a archivar, organizar y seleccionar los artículos por título y resumen.

Selección de Estudios y Extracción de Datos

El proceso de selección de estudios fue realizado de forma independiente en dos etapas por dos revisores, y un tercer revisor resolvió los conflictos. En la primera etapa se revisaron los títulos y resúmenes para excluir los artículos que no cumplían los criterios de inclusión. Si la elegibilidad de un estudio no estaba clara, se pasaba a la segunda etapa para una evaluación adicional. En esta segunda etapa, se recuperaron todos los estudios elegibles en su totalidad, se leyeron detenidamente y se analizaron. Dos revisores extrajeron los datos de forma independiente. En caso de desacuerdo, intervino un tercer revisor. Los datos extraídos incluyeron detalles sobre los autores, el año, el país, el tipo de estudio y las características de la muestra, datos sobre los programas de formación, incluida la cobertura de los participantes (número y tipo), el marco conceptual y pedagógico, los objetivos, el plan de estudios, el cronograma, la modalidad, las tecnologías utilizadas, las estrategias de enseñanza y la evaluación. Los datos se organizaron en una tabla elaborada por los autores. El formulario de extracción de datos se sometió a pruebas previas y las incoherencias se debatieron con los investigadores principales para llegar a un consenso.

Aspectos Éticos

No fue necesaria ninguna revisión ética, ya que el estudio utilizó datos secundarios de acceso público y se respetaron todas las normas sobre derechos de autor de la investigación citada.

RESULTADOS

De un total de 1.106 artículos potencialmente relevantes identificados inicialmente, se excluyeron 111 duplicados, así como 966 artículos en la revisión del título y el resumen, y 21 en la revisión del texto completo. Ocho artículos cumplieron los criterios de inclusión establecidos y se seleccionaron para la extracción de datos. La figura 1 ilustra el proceso de selección de los estudios, con los motivos documentados de las exclusiones.

Los resultados de la revisión se sintetizaron narrativamente. Las principales características de los estudios se resumen en el Cuadro 2, seguido de un análisis que describe la relación entre estas características y los objetivos y preguntas de la revisión. Las categorías y características analizadas incluyen: la caracterización de los estudios y el marco conceptual de los programas de capacitación; la organización del proceso de capacitación (objetivos, programa, cronograma, modalidad y tecnología utilizada); las estrategias de enseñanza y aprendizaje; y los métodos de evaluación.

Cuadro 2. Características descriptivas detalladas de los estudios incluidos (n = 8) – Lisboa, Portugal, 2023.

Citación, país	Diseño	Objetivo	Población/muestra	Guías/marcos	Características de los programas de formación	Estrategias de enseñanza y aprendizaje	Prácticas de evaluación
1 Jean A. Bachman and Kuei-Hsiang Hsueh, 2008, Estados Unidos⁽²⁴⁾.	Evaluación del programa, prueba posterior a la intervención.	Desarrollar y evaluar un programa en línea para enfermeras de programas escolares sobre el manejo de la diabetes en niños en la escuela.	N = 19 enfermeras de programas escolares	«Control de la diabetes en el entorno escolar”⁽²⁵⁾. Helping the Student with Diabetes Succeed» de NIH/CDC⁽²⁶⁾. Desarrollado a partir de la teoría de la difusión de las innovaciones de Rogers⁽²⁷⁾.	3 lecciones a lo largo de 2-3 semanas en Blackboard® que cubren la diabetes infantil, la gestión escolar, las bombas de insulina y el papel de la enfermera escolar.	Participación en presentaciones de PowerPoint® en línea. Participación en tres foros de debate. Respuestas escritas. Moderados por el profesorado.	Incluye evaluación formativa, evaluación de los objetivos de aprendizaje y comentarios sobre las preferencias de contenido, enseñanza y formato de formación.
2 Elgie et al., 2010, Estados Unidos⁽²⁸⁾.	Diseño experimental postest.	Diseño experi-mental postest. Evaluar la eficacia de un curso de preparación para emergencias asistido por ordenador para enfermeras de programas escolares.	N = 42 enfermeras de programas escolares	Teoría del aprendizaje cognitivo situado⁽²⁹⁾.	Curso en línea sobre instrucción asistida por ordenador; evalúa la seguridad en la escena y las habilidades de estabilización.	15 módulos en línea de preparación para emergencias centrados en la toma de decisiones con retroalimentación inmediata y demostraciones de habilidades.	Los conocimientos y habilidades se evaluaron mediante un examen, una encuesta de confianza y un OMES, y los vídeos fueron evaluados por médicos ajenos al grupo.
3 Heidi Putman-Casdorph and Susan Pinto 2011, Estados Unidos⁽³⁰⁾.	Diseño cuasi-experimental con evaluación previa y posterior a la intervención	Desarrollar y evaluar el aprendizaje a distancia para la formación continua en asma de las enfermeras escolares de Virginia Occidental.	N= 20 enfermeras de programas escolares.	Información básica sobre el asma según el programa National Asthma Education Prevention de los Institutos Nacionales de la Salud. Pautas para el cuidado del asma⁽³¹⁾.	Módulo piloto de educación sobre el asma: Impartido mediante tecnología de conferencia web (Wimba Live Classroom). Fisiopatología del asma, medicamentos y dispositivos de tratamiento.	Grupo 1: Recibió un módulo grabado de educación sobre el asma. Grupo 2: Recibió el módulo en directo con un instructor en línea. Las enfermeras obtuvieron unidades de formación continuada al finalizar.	Los conocimientos sobre el asma y la confianza en sí mismo se evaluaron mediante el SHPQ, que completaron los grupos de intervención antes y después del módulo, y el grupo de control por separado.
4 Cicutto et al., 2016, Estados Unidos⁽³²⁾.	Un Delphi modificado y una evaluación del programa con intervención previa y posterior.	Desarrollar y aplicar un marco basado en competencias para un plan de estudios de formación continua para enfermeros escolares.	N=40 enfermeras de programas escolares.	Las competencias del National Asthma Educator Certification Board’s Certified Asthma Educator⁽³³⁾ y el Healthy Learner Model^(34,35).	El modelo híbrido combinaba un programa en línea sobre el asma con un taller local, con 12 unidades de autoa-prendizaje en el sitio web de la Asthma and Allergy Foundation. Los participantes completaron la forma-ción a su propio ritmo.	Enfermeras de programas escolares completaron el curso en línea Manejo del asma y asistieron a talleres locales sobre cuidados del asma, con estudios de casos y evaluaciones prácticas de inhaladores.	Se evaluaron los conocimientos, la autoconfianza y las habilidades con el inhalador, y la autoeficacia se valoró de 0 a 4. El curso en línea incluía un cuestionario y evaluaba la satisfacción.
5 Lisa Blackmon-Jones, 2016, Estados Unidos⁽³⁶⁾.	Evaluación del programa con intervención previa y posterior.	Evaluación del programa con intervención previa y posterior. Compartir los hallazgos de la implementación de un enfoque estandarizado y combinado para la orientación de Enfermeras de programas escolares.	N=20 enfermeras de programas escolares.	Según el marco teórico de Patricia Benner⁽³⁷⁾.	La orientación mixta abarcó diabetes, asma, anafilaxia, cateterismos, alimentación por sonda, convulsiones, ventiladores, traqueostomía y salud mental.	El programa presenta estrategias como clases tradicionales y laboratorios de habilidades, con certificaciones de evaluación exigidas por el Estado que se completan al principio del año para un seguimiento eficaz.	Los participantes observaron mejoras en la formación y la tutoría. Para recolectar datos se realizaron autoevaluaciones, y una enfermera especialista evaluó la competencia tras la orientación.
6 Rhodes et al., 2019, Estados Unidos⁽³⁸⁾.	Evaluación del programa con intervención previa y posterior.	Evaluar la eficacia de un módulo de aprendizaje electrónico rápido para el desarrollo profesional de las enfermeras escolares en el control escolar de la diabetes.	N=1127 enfermeras de programas escolares.	Las últimas directrices del Programa Nacional de Educación Diabética para el cuidado de la diabetes en la escuela se diseñaron utilizando el marco ICARE para el aprendizaje electrónico en la formación de enfermería⁽³⁹⁾.	El módulo de aprendizaje electrónico rápido abordó la gestión de la diabetes en las escuelas, incluyendo actualizaciones sobre equipamiento, prácticas dietéticas, impactos psicológicos, gestión del tipo 2 y tres niveles de formación del personal.	El correo electrónico incluía un enlace, una carta de presenta-ción, un módulo de aprendizaje electrónico rápido con una prueba pre-post y un certificado. Un recordatorio animaba a completarlo en verano, y la fase Extend proporcionaba enlaces a recursos médicos fiables.	Los conocimientos sobre el control de la diabetes se evaluaron con preguntas de opción múltiple y verdadero-falso del módulo de aprendizaje electrónico, que incluía secciones de «cómo hacerlo» y comprobaciones de comprensión.
7 Shimasaki et al., 2019, Estados Unidos⁽⁴⁰⁾.	Evaluación del programa con intervención previa y posterior.	Evaluar el impacto de la serie «Enfermeras de programas escolares que gestionan los cuidados de la diabetes» en la colaboración y la autoeficacia de las enfermeras escolares de Colorado.	N= 60 enfermeras de programas escolares.	El Framework for 21st Century School Nursing Practice™ centrado en el alumno destaca la enfermería centrada en el alumno, apoyada en principios profesionales clave⁽⁴¹⁾ y en directrices para el control intensivo de la diabetes ⁽⁴²⁾.	El programa incluía sesiones de telesalud sobre atención diabética, con una serie ECHO de 4 semanas de dos cohortes, cada una con cuatro sesiones semanales de 1 hora.	Las sesiones apoyan el aprendizaje entre iguales mediante la presentación de casos y breves charlas didácticas, y están moderadas por un moderador, que permite hacer preguntas en directo o por chat.	Las sesiones promueven el aprendizaje entre iguales, con calificaciones de autoeficacia y satisfacción, comentarios abiertos sobre cambios en la práctica y obstáculos, y un cuestionario en línea a través de Qualtrics.
8 American Diabetes Association (ADA) 2021, Estados Unidos⁽⁴³⁾.	Página web de formación.	Preparar y formar al personal escolar para que preste la atención necesaria a los alumnos con diabetes.		Guía actualizada en línea para ayudar al alumno con diabetes a tener éxito: guía para el personal escolar.	El sitio web ofrece recursos de autoaprendizaje para el personal escolar sobre el cuidado de la diabetes, que incluyen orientación, talleres y herramientas.	ADA School Diabetes Care Tasks es un programa de formación de 19 módulos dirigido a enfermeras de programas escolares para formar a personal no clínico en el cuidado de la diabetes.	Al final de cada módulo del programa Tareas para el cuidado de la diabetes en la escuela hay disponible un post-test: Lo que el personal clave debe saber.

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Los estudios revisados abarcan desde 2008 hasta 2021, con la mayoría realizados después de 2016 (n = 5) y todos en los Estados Unidos de América (EE.UU.). La mayoría aplicó un enfoque cuantitativo (n = 6) para evaluar la eficacia de los programas de formación^{(24,28,30,36,38,40)} , mientras que uno utilizó un enfoque de métodos mixtos⁽³²⁾. Al tratarse de un programa del sitio web de la American Diabetes Association, el artículo no especifica el tipo de estudio⁽⁴³⁾.

Siete programas de formación abordaron enfermedades crónicas. Cuatro se centraron en la diabetes^{(24,38,40,43)}, dos en el asma^(30,32), uno abarcó varias afecciones crónicas y otro, la preparación para emergencias^(28,36). Todos los estudios se centraron en enfermeras de salud escolar y se adhirieron a marcos teórico-metodológicos, incluyendo guías de práctica clínica^{(24,30,32,38,40,43)}, referencias teóricas de enfermería y otras disciplinas^{(24,28,32,36,40)}, y modelos educativos innovadores utilizando tecnología^(24,38).

Los objetivos generales de los estudios recolectados se centraron principalmente en la evaluación de la eficacia y en el desarrollo de formación apoyada en la tecnología^{(24,28,30,32,38,40)}. Los objetivos específicos se centraban en el tratamiento de la diabetes^(24,38,40), el tratamiento del asma⁽³²⁾ y otras enfermedades crónicas⁽³⁶⁾, mientras que algunos estudios carecían de objetivos explícitos^(28,30,43).

La estructura del programa incluía temas como el control de la diabetes^{(24,38,40,43)}, procedimientos de emergencia⁽²⁸⁾, control del asma^(30,32) y procedimientos para afecciones crónicas⁽³⁶⁾. Los programas se clasificaron en formatos de aprendizaje electrónico y semipresencial, y la mayoría de ellos se impartieron de forma asíncrona^{(24,30,38,43)}, con sesiones síncronas ofrecidas a través de videoconferencia^(28,30,40). Todos ellos se organizaron en módulos temáticos de duración variable. Predominaron las actividades formativas breves, como un día de formación continua, sesiones de dos a diez horas y cuatro sesiones semanales de una hora cada una^{(28,30,32,40)}. El aprendizaje tuvo lugar a lo largo de un periodo de ocho meses dentro de un único programa⁽³⁶⁾. En un estudio no se especificaba el tiempo necesario para completar las actividades, pero se recomendaba completarlas durante el verano⁽³⁸⁾. El contenido del sitio web de la ADA era accesible un número ilimitado de veces, lo que permitía a los alumnos establecer su propio ritmo de aprendizaje.

Las estrategias educativas se basaron en la tecnología, como los sistemas de gestión del aprendizaje^(24,30,32), los recursos de correo electrónico personalizados⁽³⁸⁾ y las herramientas de colaboración en línea⁽²⁴⁾. Se hizo hincapié en el aprendizaje basado en casos mediante sesiones tanto asíncronas como síncronas⁽⁴⁰⁾. Se utilizaron escenarios audiovisuales y retroalimentación inmediata para mejorar las experiencias de aprendizaje⁽²⁸⁾. El sitio web de la ADA ofrecía una serie de recursos, como talleres virtuales, estudios de casos y listas de comprobación de competencias para enfermeras de programas escolares⁽⁴³⁾.

Los formatos de aprendizaje mixto combinaban módulos en línea con talleres presenciales basados en problemas⁽³²⁾. También se utilizaron estrategias innovadoras, como laboratorios de habilidades y formación en documentación por ordenador⁽³⁶⁾. Dos estudios controlaron el número de participantes para garantizar la calidad^(24,40).

La evaluación se centró en la autoeficacia, la confianza, la adquisición de conocimientos y el desarrollo de habilidades^{(24,28,30,32,36,38,40)}. La calidad del programa se evaluó en tres estudios^(24,36,40), aplicándose a menudo evaluaciones sumativas. Un estudio destacó las evaluaciones formativas⁽²⁴⁾. Se emplearon diversas herramientas de evaluación, como escalas de Likert, preguntas de verdadero-falso y escalas analógicas visuales. Las evaluaciones sumativas incluyeron escenarios simulados filmados y gestión de casos ^(28,36).

DISCUSIÓN

Este estudio mostró los elementos esenciales de los programas de formación mediados por tecnología para profesionales de la salud escolar. Aquí se destacan los objetivos y las preguntas de investigación. Aunque nuestra investigación fue global y abarcó tres idiomas, todos los estudios identificados se realizaron en EE.UU. y se centraron en enfermeras escolares. Es probable que esto esté relacionado con el papel diferenciado que desempeñan estos profesionales en el contexto estadounidense. En EE.UU., las enfermeras de programas escolares son esenciales para promover la salud, el bienestar y el éxito educativo de los alumnos, ya que a menudo son los únicos profesionales sanitarios en los centros escolares^(3,13,44,45). La NASN, creada en 1968, refuerza este enfoque estructurado proporcionando directrices como el modelo^21st Century School Nursing Practice™ y abogando por la presencia a tiempo completo de enfermeras escolares^(41,46). Con aproximadamente 132 300 enfermeras escolares en los EE. UU.⁽⁴⁷⁾, la inversión continua en su desarrollo profesional está respaldada por sistemas nacionales de evaluación, como la Encuesta Nacional de Salud Infantil⁽⁴⁸⁾, que informan las políticas de salud escolar. Por el contrario, Europa muestra un importante vacío en la investigación sobre este tema, a pesar de las recomendaciones de la Red Europea de Escuelas Promotoras de Salud, que hace hincapié en la necesidad urgente de seguir investigando y de aplicar políticas de integración de la salud en las escuelas⁽⁴⁹⁾. Además, en otras regiones del mundo, como América Latina, África y partes de Asia, tampoco se han identificado programas de formación estructurados en este campo de la salud escolar.

Esta Revisión de alcance incluyó estudios publicados en portugués, inglés y español, con la intención de dar una visión global de las prácticas mundiales. Sin embargo, a pesar de este enfoque inclusivo, todos los estudios incluidos se originaron en los Estados Unidos, lo que demuestra un sesgo geográfico significativo en la literatura. Esta limitación refleja la sobrerrepresentación de los contextos anglófonos y pone de relieve la falta de estudios de regiones como América Latina, que comparten similitudes lingüísticas pero están infrarrepresentadas en el corpus de investigación global.

América Latina presenta una oportunidad única para la investigación debido a su gran diversidad étnica y cultural y a sus distintos determinantes sociales de la salud⁽⁵⁰⁾. La investigación en esta región ha sido escasa, no sólo en el ámbito de la formación en salud escolar, sino también en otros ámbitos de la salud pública⁽⁵¹⁾. Para llenar estas brechas es necesario un esfuerzo consciente por incluir diversas voces y resultados de la investigación, promoviendo así una comprensión más completa de los retos y las soluciones de la salud mundial. Ampliar el ámbito geográfico de la investigación es crucial, no sólo para garantizar la inclusión, sino también para adaptar las intervenciones a las circunstancias culturales y contextuales.

Los datos revelaron un importante vacío en las estructuras pedagógicas de los programas de formación mediados por tecnología. Aunque los programas integran la tecnología para el aprendizaje a distancia, la mayoría no se ajustan a los modelos pedagógicos establecidos, convirtiendo a menudo las prácticas tradicionales en formatos virtuales⁽⁵²⁾. Sólo dos programas incorporan modelos pedagógicos: el modelo ICARE - Introducción, Conexión, Aplicación, Reflexión y Extensión⁽³⁹⁾ y el modelo de Difusión de Innovaciones de Rogers⁽²⁷⁾, destacando la importancia de fundamentar los programas mediados por tecnología en principios pedagógicos sólidos. El uso de la tecnología con fines educativos es esencial y requiere un apoyo pedagógico en las estructuras, los actores y las estrategias de enseñanza⁽⁵³⁾. En un marco de e-actividades, el diseño de actividades en línea con estrategias pedagógicas intencionadas es crucial para promover el compromiso y la participación activa, yendo más allá de la simple transferencia de prácticas tradicionales a formatos digitales⁽⁵⁴⁾. Del mismo modo, para que la educación en línea sea eficaz es necesario estructurar los cursos basándose en teorías pedagógicas que faciliten interacciones significativas⁽⁵⁵⁾, como el modelo de Comunidad de Investigación⁽⁵⁶⁾, asegurándose de que los programas potenciados por la tecnología sean algo más que innovadores: son pedagógicamente sólidos. Los programas educativos en línea se consideran enfoques innovadores y complementarios⁽⁵⁷⁾, y el aprendizaje combinado, en particular, tiene el potencial de aumentar la eficacia y la eficiencia de las actividades educativas⁽⁵⁸⁾.

Estos programas estaban fuertemente influenciados por un enfoque práctico, incorporando pautas basadas en directrices recomendadas. También se observó que la influencia de los modelos teóricos de enfermería, como el marco centrado en el estudiante de la 21st Century School Nursing Practice™⁽⁴⁷⁾ y el modelo de Benner⁽³⁷⁾, puede ser crucial para estructurar la práctica enfermera y enriquecer la experiencia educativa⁽⁵⁹⁾.

La definición de CSHCN no se limita a la presencia de un diagnóstico clínico, sino que abarca las consecuencias que una condición puede generar en diversos ámbitos, lo que hace que el concepto sea más amplio e inclusivo⁽⁶⁰⁾. Sin embargo, los programas identificados en esta revisión de investigación tienden a centrarse en condiciones de salud específicas. Los programas analizados tienden a priorizar afecciones destacadas en el perfil epidemiológico de los niños que requieren intervenciones urgentes, como la diabetes y el asma, probablemente debido al alto riesgo de resultados graves o mortales^{(61, 62, 63)}.

Los programas de formación fueron fundamentales en todos los estudios recolectados, promoviendo intervenciones educativas que proporcionaron a las enfermeras los conocimientos, las habilidades y la confianza necesarios para prestar cuidados de calidad. Estos hallazgos confirman el impacto positivo de la formación continuada en el mantenimiento de unos cuidados de enfermería de alto nivel⁽⁶⁴⁾. La formación continua es esencial para la gestión eficaz de las necesidades sanitarias especiales en el entorno escolar, y ésta debe adaptarse a las necesidades específicas de las enfermeras⁽⁶⁵⁾.

Las estrategias docentes aplicadas en los estudios iban desde módulos de PowerPoint hasta foros de debate interactivos, promoviendo tanto el aprendizaje autónomo como el colaborativo. Se hace hincapié en la necesidad de entornos que faciliten la interacción entre enfermeras, así como en la flexibilidad que proporcionan las tecnologías digitales. Además, el e-learning ha surgido como una alternativa eficaz para la formación continuada en enfermería, demostrando resultados positivos en términos de satisfacción, flexibilidad y relevancia de los contenidos^(45,66,67).

Todos los estudios analizados destacaron la importancia de detallar cómo se produce la evaluación de los conocimientos, el desarrollo de habilidades, la autoeficacia y la confianza profesional de las enfermeras, integrando las prácticas de evaluación en la planificación de la formación. La formación basada en competencias pretende mejorar los resultados en salud de la población⁽⁶⁸⁾. Los resultados de esta revisión indican que tales programas pueden reforzar la autoeficacia y la confianza de las enfermeras escolares⁽⁶⁹⁾. La autoeficacia influye en la percepción de la capacidad de modificar conductas, lo cual es crucial para la adquisición de habilidades clínicas⁽⁷⁰⁾. Aunque no se mencionó, el modelo de evaluación de Kirkpatrick se utiliza ampliamente para medir la eficacia de la formación a través de cuatro niveles⁽⁷¹⁾.

Los resultados muestran que las evaluaciones realizadas se centraron predominantemente en el componente sumativo, descuidando la evaluación formativa, que es crucial para monitorear el proceso de aprendizaje durante el diseño y desarrollo de la formación. Además, la mera incorporación de las tecnologías a la evaluación no garantiza una transformación eficaz de los métodos de evaluación⁽⁷²⁾. Esto subraya la urgencia de realizar adaptaciones en la evaluación en respuesta a los cambios en los entornos educativos derivados de la migración a espacios digitales⁽⁷³⁾. También es fundamental explorar nuevos paradigmas de evaluación y autoevaluación en modelos de formación mediados por tecnología, reconociendo y valorando la diversidad de métodos de evaluación digital. Para ello, se recomienda integrar tareas y actividades de evaluación que simulen situaciones de la vida real⁽⁷²⁾. En este contexto, la implementación de la evaluación continua refuerza la estructura del modelo de evaluación, enfatizando su función formativa y promoviendo el desarrollo de los alumnos al situarlos en el centro del proceso educativo.

Esta revisión tiene sus limitaciones, como por ejemplo, la búsqueda incluye solamente de estudios en inglés, portugués o español. A pesar de estas limitaciones, se identificaron ciertas lagunas de conocimiento, proporcionando ideas para futuras investigaciones y sugiriendo un enfoque para el desarrollo de programas de formación mediados por tecnología centrados en las necesidades especiales de salud en un contexto escolar.

CONCLUSIÓN

Esta Revisión de alcance reveló implicaciones metodológicas y prácticas significativas para el desarrollo de programas de formación dirigidos a equipos escolares, centrados en las necesidades especiales de salud. El uso de múltiples recursos digitales enriquece la formación, fomentando el aprendizaje tanto individual como colaborativo. De cara al futuro, es crucial abordar la falta de un marco pedagógico sólido para los entornos digitales, la necesidad de seguir investigando en los diversos ámbitos asociados a las necesidades especiales de salud, en particular los que implican el apoyo de equipos escolares interdisciplinares, y de una formación adaptada a los formatos digitales, que incorpore herramientas de evaluación formativa coherentes y adecuadas.

Footnotes

Apoyo financiero

Este trabajo fue realizado en parte con el apoyo del Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brasil (CNPq) proceso: 401923/2024-0 (versión en español).

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PERMALINK

Technology-mediated training programs for school health teams on special health care needs: a scoping review

Programas de treinamento mediados por tecnologia para equipes de saúde escolar sobre necessidades especiais de saúde: uma revisão de escopo

Maria do Céu Coelho Monteiro Pires

Maria do Céu Aguiar Barbieri - Figueiredo

Daniela Filipa Batista Cardoso

Filipa Margarida Duque

Maria Sandra Tricas-Sauras

Mirko Prosen

Eva Guilherme Menino

ABSTRACT

Objective:

Method:

Results:

Conclusions:

RESUMO

Objetivo:

Método:

Resultados:

Conclusões:

INTRODUCTION

METHOD

Design of Study

Data Sources and Research Strategy

Chart 1. Scoping review search strategies – Coimbra, Portugal, 2021–2022.

Study Selection and Data Extraction

Ethical Aspects

RESULTS

Figure 1. PRISMA diagram of the article search and selection stages(23).

Chart 2. Detailed descriptive characteristics of the included studies (n = 8) – Lisboa, Portugal, 2023.

DISCUSSION

CONCLUSION

Funding Statement

Footnotes

REFERENCES

Programas de capacitación mediados por tecnología para equipos de salud escolar sobre necesidades especiales de atención de salud: una revisión del alcance

Maria do Céu Coelho Monteiro Pires

Maria do Céu Aguiar Barbieri - Figueiredo

Daniela Filipa Batista Cardoso

Filipa Margarida Duque

Maria Sandra Tricas-Sauras

Mirko Prosen

Eva Guilherme Menino

RESUMEN

Objetivo:

Método:

Resultados:

Conclusiones:

INTRODUCCIÓN

MÉTODO

Diseño del Estudio

Fuentes de Datos y Estrategia de Investigación

Cuadro 1. Estrategias de búsqueda de la revisión de alcance – Coimbra, Portugal, 2021–2022.

Selección de Estudios y Extracción de Datos

Aspectos Éticos

RESULTADOS

Figura 1. Diagrama PRISMA de las etapas de búsqueda y selección de artículos(23).

Cuadro 2. Características descriptivas detalladas de los estudios incluidos (n = 8) – Lisboa, Portugal, 2023.

DISCUSIÓN

CONCLUSIÓN

Footnotes

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases

Figure 1. PRISMA diagram of the article search and selection stages⁽²³⁾.

Figura 1. Diagrama PRISMA de las etapas de búsqueda y selección de artículos⁽²³⁾.