Bridging the gap – from improvisation to innovation: Toward a specialised curriculum for hospital school educators [peer-reviewed]

European Journal of Special Needs Education ISSN: 0885-6257 (Print) 1469-591X (Online) Journal homepage: www.tandfonline.com/journals/rejs20 Bridging the gap - from improvisation to innovation. Toward a specialised curriculum for hospital school educators Dennis Christian Hövel, Ankica Jurkic, Kathrina Walther, Pierre-Carl Link & Robert Langnickel To cite this article: Dennis Christian Hövel, Ankica Jurkic, Kathrina Walther, Pierre-Carl Link & Robert Langnickel (26 Nov 2025): Bridging the gap - from improvisation to innovation. Toward a specialised curriculum for hospital school educators, European Journal of Special Needs Education, DOI: 10.1080/08856257.2025.2594696 To link to this article: https://doi.org/10.1080/08856257.2025.2594696 © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Published online: 26 Nov 2025. Submit your article to this journal View related articles View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=rejs20 Bridging the gap - from improvisation to innovation. Toward a specialised curriculum for hospital school educators Dennis Christian Hövel a , Ankica Jurkic a , Kathrina Walther a,b , Pierre-Carl Link a and Robert Langnickel c a Institute for Educational Support for Behaviour, Social-Emotional, and Psychomotor Development, University of Teacher Education in Special Needs, Zurich, Switzerland; b Institute for Special Education, University of Wuerzburg, Wuerzburg, Germany; c Institute for Diversity and Inclusive Education, University of Teacher Education, Lucerne, Switzerland ABSTRACT Hospital schooling plays a critical role in ensuring educational continuity for chronically ill students. However, the field remains largely informal in Germany, Austria, and Switzerland, with significant gaps in systematic teacher training and professional support. This trinational study used an online-based needs assessment to evaluate current practices and identify core areas for professional development. Findings reveal high teacher commitment but substantial deficits in medical knowledge, specialised pedagogy, and institutional support structures. The study underscores the urgent need for standardised, interdisciplinary curricula and proposes actionable strategies for educational policy and practice. These findings contribute significantly to the international discourse on professionalisation of educators in health contexts. ARTICLE HISTORY Received 19 May 2025 Accepted 20 November 2025 KEYWORDS Hospital schooling; teacher professionalisation; special education; chronic illness; curriculum development; educational support Introduction The education and psychosocial support of children and adolescents with chronic illnesses pose significant challenges for modern education systems. In Germany, Austria, and Switzerland, an estimated 12–16% of children and adolescents are affected by long-term health impairments (Dratva et al. 2020; Neuhauser and Poethko-Müller 2014). The report of the Swiss Health Observatory (Dratva et al. 2020) highlights the broad spectrum of these conditions, which often entail not only physical limitations but also psychological distress and social exclusion. Furthermore, the report underscores the necessity of cross-sector collaboration between education, healthcare, and social services. The educational sector, in particular, is crucial in providing psychosocial support to affected children. Initiatives such as school health services, multi-professional teams, and specially trained teachers could enhance educational opportunities and foster social inclusion. In this context, hospital schools and similar specialised educational institutions are gaining increasing importance, as they enable children with illnesses to continue their education CONTACT Dennis Christian Hövel [email protected] EUROPEAN JOURNAL OF SPECIAL NEEDS EDUCATION https://doi.org/10.1080/08856257.2025.2594696 © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. seamlessly and facilitate their eventual reintegration into the regular school system. Findings from international contexts underscore this significance: A Finnish study by Äärelä, Määttä, and Uusiautti (2018) illustrates the complexity of collaboration between hospital school teachers and parents, which is crucial for ensuring pedagogical continuity and emotional support throughout hospitalisation and reintegration. Recent German School Barometer (Robert 2024) findings emphasise the immense strain teachers face when dealing with heterogeneous classrooms. More than half of the surveyed teachers report being overwhelmed by the diversity of students’ learning needs, and 71% experience this heterogeneity as a significant burden in their daily work. At the same time, many schools lack structured support systems and specialised offerings for students with psychosocial difficulties, which are often rated only ‘satisfactory to poor’. These findings underscore the urgent need for professional support and targeted qualification programmes – particularly in settings such as hospital schools, where medical, emotional, and educational dimensions must be addressed in tandem. Todis, McCart, and Glang (2018) further emphasise that even in systems where hospital-to-school transition services exist, their provision is often inconsistent and educators frequently lack the knowledge to implement hospital recommendations effectively. This underlines the necessity for structured qualifications in interdisciplinary communication and individualised transition planning. The WHO (2023) also emphasises the importance of health-promoting school measures, particularly for vulnerable groups such as children and adolescents with chronic illnesses. While the right to education for these students is legally enshrined, in practice, the question arises as to how this right can be effectively implemented in a manner that accommodates both their health needs and educational requirements (Haegele and Hodge 2016). Despite decades of discussions on the professionalisation of teachers in this field, there is still no officially recognised or standardised curriculum for hospital school educators in Germany, Austria, or Switzerland. This gap results in insufficient systematic qualification of teachers and complicates the development of coherent and effective educational programmes for affected students. Given the particular challenges arising from the heterogeneity of illnesses, organisational frameworks, and multiprofessional demands, specific qualifications for teachers in this area are essential (Neuhauser and Poethko-Müller 2014). Indeed, discussions since the 1970’s have acknowledged the need for specialised training for teaching during illness. Still, to date no curricular or staterecognised training or further education exists in the German-speaking countries. This lack of formalisation has led to unclear responsibilities (political, financial, scientific, and pedagogical) and an absence of systematic evaluation of pedagogical action in this field (Blanc 2014). Moreover, there is a persistent lack of interconnection between practical expertise and scientific knowledge (Castello and Pülschen 2018), which is problematic because students especially need timely and appropriate educational support in stressful situations such as illness. The illness-specific educational support requirements thus lead to special demands on teachers. To foster professional competence within a system, the COACTIV model provides a robust structural framework (Baumert and Mareike 2011). Professionalisation is understood as the interaction of four interrelated domains, 2D. C. HÖVEL ET AL. which can be adapted for research in Pb-KuS (Elbracht et al. 2025). In line with the needs assessment and the study’s aim to identify key components of competence development in Pb-KuS, the investigated dimensions are based on this model. Specifically, the study focuses on professional knowledge and motivational dispositions as core elements of professional competence. Professional knowledge includes subject-matter, pedagogical-content, pedagogical-psychological, and organisational knowledge, while the motivational dimension encompasses intrinsic motivation and self-efficacy beliefs. The legal framework for hospital schooling is grounded in international and national regulations. Internationally, the UN Convention on the Rights of Persons with Disabilities (United Nations 2006) and the UN Convention on the rights of Children (Convention on the Rights of the Child 1989) ensure equal and non-discriminatory access to education, regardless of health status. In Switzerland, the Conference of Cantonal Ministers of Education (EDK) delegates responsibilities to cantons. In Germany, the Standing Conference of the Ministers of Education (Bildungsminister Konferenz 2025) defines education for long-term ill students in different settings under the supervision of local school authorities. In Austria, regulations are being described by the Federal Ministry of Education (BMB 2017) formally recognises hospital schools, ensuring educational continuity during illness. Internationally, established concepts and training structures for hospital school educators already exist. In the United States and China, specialised programmes have been developed that provide teachers with both pedagogical and basic medical knowledge. These approaches reflect the understanding that hospital school educators must possess didactic and pedagogical skills and have a fundamental understanding of medical conditions, treatment processes, and psychosocial aspects (Lightfoot, Wright, and Sloper 1999; Mukherjee, Lightfoot, and Sloper 2000). In contrast, hospital school pedagogy remains marginal in teacher education in German-speaking countries. Experiences from Taiwan (Chen et al. 2015) reveal similar challenges: Even in a highly efficient healthcare system, hospital-based education is often informal, fragmented, and insufficiently institutionalised. The study calls for policy-level advocacy and professional training to ensure equitable access to education for children with chronic illnesses. Training is often informal or occurs only on the job, leading to significant disparities in professionalisation and a lack of systematic networking between universities and hospital schools (Kremsner et al. 2023; Langnickel et al. 2024). The absence of standardised training means that teachers must rely on individual experiences and collegial networks to navigate the diverse challenges of their practice. Despite decades of international recognition, the systematic professionalisation of hospital school educators remains severely underdeveloped, particularly in German-speaking contexts. Taken together, these insights highlight a shared pattern across different healthcare and educational systems: Despite the known benefits of hospital schooling for children with chronic conditions, systemic implementation often remains inconsistent, underfunded, or insufficiently professionalised. Bridging this gap requires not only national policy initiatives, but also robust cross-sector collaboration and formalised teacher training programmes that address the medical-pedagogical interface. This study aims to bridge the existing research gap by conducting a systematic needs assessment and developing concrete recommendations for establishing specialised EUROPEAN JOURNAL OF SPECIAL NEEDS EDUCATION 3 teacher education in Germany, Austria, and Switzerland. Using an online-based questionnaire, the study addresses two central research questions: (A) How do hospital school teachers evaluate the existing procedures and processes in their daily professional practice? (B) What are the needs identified by teachers in hospital schools? The investigation considers both the existing challenges and the opportunities for structured professional development in this field. The findings provide a scientifically grounded basis for curriculum development and the implementation of a sustainable approach to professionalisation. Materials and methods Procedure The present study was part of a trinational research project Pb-KuS funded by Movetia. The study was conducted in Germany, Switzerland, and Austria with the aim of developing a curriculum for teachers in hospital schools. The research team contacted representatives of the field of hospital schools, such as school principals and clinic managers, and asked them to select professionals to participate in the study. The professionals had to be involved in educational activities in hospital schools and/or in a home school and/or in a resuming school (i.e. the school to which a student returns). Data were collected over six weeks in February and March 2024 using an online questionnaire. School principals and clinic managers distributed the questionnaire link to the professionals. Participation was voluntary and unpaid. Sample/participants The sample consisted of 230 participants (73.5% female). The majority of respondents identified as classroom teachers (38.3%), subject teachers (17.4%), or school principals (20.9%), with an additional 21.6% working in multiple roles. Participants were primarily from Germany (66.5%), Switzerland (13.9%), and Austria (16.1%). Most (71.7%) were working in formally independent schools under the usual school administration hierarchy, whereas 13% were working in hospital schools formally attached to a clinic (with the head physician as supervisor). The majority of the sample worked exclusively in psychiatric clinics or departments (53.9%) or in somatic illness settings (21.7%), followed by a small percentage working in a student’s original school or a receiving school (about 3% each). A notable proportion (16.8%) worked across more than one type of setting. Over half of the participants (50.9%) reported working with children encompassing psychological, somatic, and psychosomatic illnesses; 30.9% worked only with children with psychological illnesses, 12.6% with solely somatic illnesses, and 2.2% exclusively with psychosomatic illnesses. In terms of teaching levels, only 2.2% solely taught at the primary level, 2.6% in special education, and 6.1% at the secondary level, while the majority 4D. C. HÖVEL ET AL. (64.9%) taught across multiple school levels. Most participants were experienced professionals: 82.6% had more than two years of experience in their current institution. Regarding formal qualifications, 2.6% held a doctorate, 53.5% had a second state examination in teaching (a standard terminal qualification for teachers in Germany), 30.4% held a Master’s degree, 10.0% a Bachelor’s degree, and 17.8% reported other qualifications (including therapeutic or nursing qualifications such as physiotherapy or kinesiology certification). Instruments The online questionnaire included both closed and open-ended items covering several domains. It gathered information on participants’ professional biography and everyday working life (e.g. current role, setting, tasks, and experiences), their perceptions of existing school processes and curricula, and their self-reported expertise and professional development. For example, participants were asked to list all their tasks/responsibilities in the hospital school, what they enjoy about their work, and what they find challenging in their work. They were also asked whether a specific curriculum for hospital schooling exists at their institution and to rate their satisfaction with certain aspects of their work (such as teaching across different school levels and managing transitions between hospital school and mainstream education). In addition, the survey included questions evaluating existing pre-service training and in-service training or continuing education opportunities for hospital school teaching, using 7-point Likert scales (1 = very insufficient to 7 = excellent). Participants were asked if they had ever attended any training related to pedagogy for illness and to rate the adequacy of current training offerings. Open-ended questions invited respondents to elaborate on their needs and suggestions for further training, specific knowledge they deem necessary for the job, and any other support they would find beneficial (such as supervision or networking). The questionnaire was reviewed by experts from the field before distribution to ensure content validity and clarity (social validation). Data analysis Quantitative data from closed questions were analysed using descriptive statistics (means, standard deviations, and frequency distributions) with SPSS 29. Likert-scale items are reported with mean (M) and standard deviation (SD). Qualitative data from open-ended questions were analysed using inductive content analysis, following Mayring’s (2015) established qualitative content analysis approach, widely used in German-speaking educational research contexts. Two researchers independently coded the qualitative responses, iteratively developing a category system. Initial categories were derived inductively from a subset of responses (approximately 25% of the data), and the category system was then refined and applied to the full dataset. During this process, new categories were added as needed and others were merged or adjusted (forming a final catalogue of categories capturing the main themes in participants’ answers). Regular team discussions were held to achieve consensus on the coding, and discrepancies were resolved through reflection on the meaning of responses. Cohen’s κ ranged from .75 to .87, with a total of .81. This qualitative analysis allowed for the extraction of key themes and ‘big points’ raised by participants, which complement the quantitative findings. Table 1 provides an overview of EUROPEAN JOURNAL OF SPECIAL NEEDS EDUCATION 5 the main inductively derived categories from the qualitative content analysis, including Cohen’s Kappa values and number of coded segments per subcategory. Results Professional background and current practices The current landscape of hospital schooling in Germany, Austria, and Switzerland is characterised by a largely experienced and highly committed group of teachers working in diverse roles and settings. Almost all participants reported that they regularly collaborate with various professionals in their daily work, reflecting a high degree of interdisciplinarity. For example, teachers indicated that they maintain contact with medical staff (doctors, nurses, therapists), parents, school administrators of the students’ home schools, and other specialists to provide holistic support to the student. Many respondents listed a wide range of responsibilities – from delivering individualised instruction across multiple subjects and grade levels, to coordinating with healthcare professionals, to managing students’ transition back to their original schools. When asked what they appreciate about working at a hospital school, teachers most frequently mentioned the variety and meaningfulness of their work. They highlighted varied tasks and the creative freedom in lesson design as positive aspects. The ability to work individually with children and adolescents and to tailor education to each student’s needs was seen as a major advantage of this setting. Furthermore, many respondents valued the close multi-professional collaboration, noting that working with different professions (e.g. healthcare providers, social workers) enriched their practice and allowed them to support students more comprehensively. However, some challenges were reported. A few teachers pointed out structural or administrative difficulties, such as unclear responsibilities or a lack of resources and time, which can hinder their work. However, overall job satisfaction in this field appears to be high. Table 1. Overview of inductively derived main categories from the qualitative content analysis, including Cohen’s κ values and number of coded segments per subcategory. Category Subcategory Cohen’s Kappa Number of ratings Everyday working life Beneficial aspects .76 592 Hindering aspects .80 287 Professional enrichment and challenges. Enrichment .75 336 Challenges .75 282 Professional competences Personal skills .87 452 Didactic skills .83 206 Pedagogical-psychological skills .81 283 Identified needs Specific needs and support .80 363 Specific topics for additional training or further education/training .75 91 Structure of additional and/or further training .81 155 Subject-specific didactic content .83 29 Content beyond specialised didactic .78 75 Suggested teaching and learning methods .79 195 Total .81 3346 6D. C. HÖVEL ET AL. Indeed, a striking finding is that an overwhelming majority of respondents consider their position to be their dream job. Specifically, 86.7% of the teachers (among those who responded to this item, n = 117) reported that working at a hospital school is their dream job. Despite the inherent challenges, this suggests a strong vocational commitment and positive identification with their role. Furthermore, teachers also reported being satisfied with teaching across different school types and age groups. They were asked to rate their satisfaction with instructing students from various school levels (since in hospital schools one teacher may teach primary through secondary content). The mean satisfaction was high (5.5 on a 7-point scale, indicating between ‘somewhat satisfied’ and ‘very satisfied’), reflecting that most teachers do not view the heterogeneity in student academic levels as a burden. This finding is noteworthy given that heterogeneity in mainstream classrooms is often cited as a stress factor for teachers. It appears that hospital school teachers, perhaps due to specialised mindset or smaller class groups, manage diversity of academic needs well and even embrace it as part of their job. Another important aspect of teachers’ daily work is managing students’ transitions between their home schools and the hospital school. Respondents were asked to evaluate the procedures for transitioning students from the mainstream school to the hospital school and back to the mainstream school after recovery. The overall assessment of these transition processes was positive. On a 7-point scale (1 = very unsatisfied, 7 = very satisfied), the average ratings for transition management were above the neutral midpoint. Teachers rated the transition from the home school into the hospital school at M = 5.2 (SD = 1.5) and the transition from the hospital school back to mainstream education at M = 5.0 (SD = 1.6). In practical terms, many teachers reported well-established communication channels with the home schools and a general satisfaction with maintaining students’ educational continuity. Qualitative comments reinforced this: teachers mentioned that flexible curricula and good cooperation between institutions help ensure that students reenter their regular classes as smoothly as possible. Nevertheless, a few challenges were noted, such as occasional gaps in communication or differences in expectations between hospital school teachers and mainstream teachers. Despite these, the majority of participants described the transition processes as functioning rather well, indicating a generally effective transition management in current practice. Evaluation of training and identified needs A central goal of this study was to assess existing training and education programmes for hospital school teachers and to identify the needs perceived by practitioners in this field. The results reveal a clear message: teachers feel that current training opportunities are inadequate and strongly desire more specialised preparation and support. Most teachers in our sample (72.6%) had at some point participated in a training or further education programme related to teaching in the context of illness. Despite this, their ratings of both initial teacher education and continuing training specific to hospital schooling were very low. On a 7-point scale ranging from 1 (insufficient) to 7 (excellent), respondents on average rated the current initial training offerings at M = 2.09 (SD = 1.30) and the continuing education offerings at M = 2.95 (SD = 1.67). These means are close to the ‘insufficient/poor’ end of the scale, highlighting that teachers perceive a significant gap in formal preparation for the demands of their job. In openended comments, many teachers noted that they primarily learned how to teach ill students EUROPEAN JOURNAL OF SPECIAL NEEDS EDUCATION 7 through practice or through informal peer exchange, rather than through structured programmes. When asked what improvements they would like to see in training and professional development, 112 teachers provided concrete suggestions. Table 2 summarises the most frequently mentioned needs and support wishes expressed by participants in the open-ended responses. The most frequently mentioned need – by far – was for a broader range of training content in medical knowledge. Teachers feel they require more medical background knowledge to teach and support students with various health conditions effectively. This was echoed in multiple parts of the survey: for instance, in a separate question about necessary knowledge for working in hospital schools, 101 respondents (almost half the sample) explicitly highlighted medical knowledge (such as understanding illnesses, treatments, and their implications for learning) as essential. Beyond medical topics, teachers also called for more training in pedagogy tailored to students experiencing illness (mentioned by 9 respondents) and in communication skills (mentioned by 7 respondents) – for example, skills for communicating with healthcare professionals, with parents, or with students who may be anxious or in pain. Additionally, some participants pointed to the need for knowledge about legal and organisational aspects of hospital schooling (e.g. rights of students, coordination with health services), though this was a less frequent theme than medical and pedagogical content. Beyond subject-matter knowledge, the survey uncovered a strong demand for professional support and networking opportunities. Many teachers expressed that working in a hospital school can at times be isolating, as there are usually only a small number of colleagues who share this specialised role. Nearly 21% of respondents (48 teachers) indicated a need for regular supervision or coaching to reflect on challenging cases and their own emotional well-being. Likewise, 36 teachers (about 16%) emphasised the importance of opportunities for networking and exchange with peers – for instance, through regional or international meetings, conferences, or online platforms where hospital school educators can share experiences and resources. Such networking could help disseminate best practices and reduce the feeling of constantly having to reinvent solutions at each hospital school. Teachers provided insightful suggestions when considering what form additional training or further education should take. A modular training structure was favoured: respondents envisioned a programme composed of modules that could be completed flexibly, possibly accumulating to a certification. This modular approach could allow differentiation for teachers Table 2. Summary of the most frequently mentioned needs and support requests expressed by participants in the open-ended responses. Subcategory Memo Number of ratings Specific needs and support Training and professional development Participants wish for more training and professional development. 112 Medical Knowledge Participants state medical knowledge as a specific need to work in the field of clinic schools 101 Supervision and Coaching Participants state more supervision and coaching opportunities as needed 48 Networking and exchange with peers Participants state a need of more networking and exchange with their peers as needed 36 (. . .) (. . .) (. . .) 8D. C. HÖVEL ET AL. References Äärelä, T., K. Määttä, and S. Uusiautti. 2018. “The Challenges of Parent–Teacher Collaboration in the Light of Hospital School Pedagogy.” Early Child Development & Care 188 (6): 709–722. https://doi. org/10.1080/03004430.2016.1230108 . Baumert, J., and K. 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