Nursing Practice and Telehealth in School Health Services: A Scoping Review

Background: The COVID-19 pandemic has propelled the adoption of telehealth in school settings, emphasising the pivotal role of nurses. This review explores the last decade’s evidence on telehealth interventions in school nursing practice; Methods: Following Joanna Briggs Institute guidelines, we conducted a systematic search in PubMed, CINHAL, and Web of Science in March 2023. Out of 518 articles across 21 journals, 32 satisfied the review criteria. The selection process rigorously adhered to PRISMA-ScR guidelines for scoping reviews; Results: The results were categorised into three main areas: (a) the purpose of telehealth and intervention strategies, (b) the role of nursing in school-based telehealth practice, and (c) perceived benefits and limitations of school-based telehealth studies. Telehealth interventions encompass health promotion, mental health management, and early diagnosis. School nurses play a multifaceted role, including management, education, and remote monitoring. While telehealth offers advantages like improved health and cost savings, challenges include digital literacy, device access, and costs; Conclusion: This review underscores the crucial role of telehealth in schools for enhancing healthcare delivery in educational settings. However, more empirical evidence is required to specify nurses’ contributions to school-based telehealth interventions. Promoting their leadership through stakeholder collaboration is essential. Further research should address challenges and opportunities in school nursing practice, enriching healthcare in educational settings.


Introduction
Telehealth, defined as the provision of medical care at a distance [1], is not a new concept; interest in telehealth within the scientific community was growing before the COVID-19 pandemic, and the need to implement this tool in health interventions has been identified [2,3].Opinions regarding its efficacy vary widely, with concerns raised about establishing a therapeutic connection due to the absence of face-to-face interactions [4], limitations in conducting comprehensive physical examinations [5], and potential discrepancies in access, posing challenges for specific population subsets [6].
However, the undeniable merit of telehealth has been substantiated by its substantial socioeconomic benefits for patients, families, healthcare professionals, and the healthcare system at large.Notably, it enhances the relationship between professionals and patients, particularly in chronic disease management [7,8].This modality offers greater job security to professionals by facilitating information accessibility and inter-service coordination [9,10].Advocating for its significance, the National Association of School Nurses (NASN) underscores the value of telehealth in augmenting access to school and community health services, suggesting its potential to streamline health support for school children while minimising interruptions to academic pursuits [11].Telehealth at school helps schoolchildren focus on learning, facilitates access to different types of care, and reduces time away from classes as well as parental travel [12].
The context of the COVID-19 pandemic was a catalyst for monumental shifts in education delivery worldwide [13].This circumstance incited paradigm shifts in nursing roles within schools, catalysing the emergence of novel care modalities and transforming how nurses interact with students and families [14,15].The pandemic necessitated the swift launch of telehealth services, especially critical for monitoring and supporting schoolchildren confined to their homes [2].
During the pandemic, school nurses were compelled to pivot routine services into remote delivery [16], confronting exacerbated chronic issues such as childhood obesity [17], sedentary behaviours [18], and complications in managing diabetic patients [19].Additionally, they undertook newer responsibilities brought about by the pandemic, including infection control [20], development of evidence-based educational materials [21], and personal care and homeschooling.School nurses became pivotal figures, ensuring a safe learning environment by implementing prevention strategies, symptom management, testing procedures, and contact tracing, extending support not only to students but also to their families and school staff [22].
Various studies highlight the leadership role of school nurses in preventing infection and controlling the pandemic in the school population [23,24].Their interventions improved communication between the home, school, and healthcare providers [25].Children and adolescents were one of the groups most affected by the psychosocial impact of the pandemic [26][27][28], which led to mental health complications such as hyperactivity [29], bad behaviour problems, aggression and agitation [30], sleep disorders [31,32], mood disorders, and self-harming behaviours [33].School nurses were key to guiding families and the rest of the educational community, constituting a physical, emotional, and social safety net [22].
However, integrating telehealth into school settings predates the pandemic, prompting an essential inquiry into how nurses can deliver safe, high-quality care through this medium.While the utility of telehealth in general health services has been extensively explored, studies elucidating the application of telehealth in school health services and the role of school nurses in these practices remain relatively limited.Several experts advocate for comprehensive research in this domain [34,35].
While literature reviews concerning the usefulness of telehealth in generalist services [36] and its application among young individuals outside the school setting [37] exist, there is a notable absence of reviews examining the scope and depth of evidence about telehealth interventions specifically within the school environment.
The overarching questions guiding this scoping review are as follows: (a) What telehealth intervention strategies have been implemented in school health services, particularly concerning the COVID-19 pandemic?(b) What role did nurses have in the practice of telehealth?(c) What benefits and limitations were associated with these interventions?
The primary objective of this exploratory review is to ascertain the scope and nature of evidence concerning telehealth interventions in school nursing practices over the last decade and to explore the extent to which nurses can deliver safe and high-quality care through telehealth.

Study Design
The scoping review method provided us with the opportunity to incorporate diverse methodologies (i.e., quantitative and qualitative studies) to identify the nature and extent of our research [38].This scoping review adhered to the guidelines specified in the Joanna Briggs Institute Reviewer's Manual [39] and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist to ensure methodological rigor [40].The completed checklist is provided as Supplementary Material S1.

Eligibility Criteria
Eligibility criteria were estimated a priori.The eligibility criteria were predetermined and included a comprehensive range of research designs, encompassing original research articles, both qualitative and quantitative, without geographical limitations.Eligible study designs comprised randomised controlled trials, nonrandomised controlled trials, pre-and post-test studies, various observational studies, case reports, and qualitative investigations.This review considered documents published in English and Spanish that delineated telehealth strategies and interventions in school health services.The age range considered for participants was from 6 to 18 years.Additionally, this review did not exclude studies involving children whose ages fell outside the specified range but were relevant to interventions in school health services.Nor were documents referring to children enrolled in special education schools within these age ranges excluded.
Exclusion criteria were defined to exclude articles in languages other than English or Spanish, documents not primarily focused on telehealth in school settings, and those falling outside the realm of empirical research.Systematic or scoping reviews, short communications, letters to the editor, and brief articles were intentionally excluded from our scoping review.Additionally, exclusion criteria were applied to articles with no access to the full text, which may have arisen due to limited availability or restricted access.These criteria were implemented to uphold the quality and depth of our review.

Search Strategy
The search strategy was conducted in articles published over the last 10 years, from March 2013 to March 2023, across three prominent databases: PubMed, CINAHL, and Web of Science.PubMed and Web of Science are two of the most popular bibliographic databases for life sciences and biomedical disciplines and cover most of the medical literature [41].CINHAL is one of the most comprehensive English language databases indexing the best nursing literature, including publications from the American Nurses' Association and the National League for Nursing and the most widely used source of nursing research worldwide.Another reason for choosing these databases is that they offer a user-friendly interface with basic and advanced search functions [42].Keywords were meticulously translated into MeSH terms, ensuring comprehensive search coverage by validating synonyms and "equivalence relations".In instances where specific MeSH terms were not available, relevant keywords were incorporated to ensure total search outcomes.The search was limited to the past ten years to review the most current interventions.
To ensure inclusivity and a holistic approach to the study topic, grey literature from esteemed school nursing organisations and websites was included in the search, encompassing sources such as NASN, Colombian School Nursing Network, Chilean Nursing Society and School Health (SOCHIESE), Syndicate National de Infirmières Conseillères de Santé (SNICS), ACEESE/ACISE, AMECE, Australian Nursing and Midwifery Federation (Victorian Branch), and Scientific Society of School Nursing of Cantabria (SOCEEC).
The search strategy was a refined combination of the three primary concepts: (1) telehealth, (2) school health service, (3) school nursing.This strategy was corroborated by two senior information specialists (M.C.L. and A.S.S.) and was fine-tuned to focus on identifying telehealth interventions feasible for nurses within school settings.The detailed search strategy encompassing MeSH terms and keywords for all four databases is delineated in Supplementary Material S2.

Quality Assessment
We refrained from conducting a critical appraisal or bias assessment of the articles included in our scoping review [43].Article selection was carried out by independent researchers who adhered to predetermined eligibility criteria.The selected studies conformed to the levels of evidence for effectiveness defined by the Joanna Briggs Institute.The level of evidence available was high for most articles.Seventeen (53.12%) studies were identified as level 1 evidence, three (9.37%)studies were identified as level 2 evidence, three (9.37%)studies were identified as level 3 evidence, eight (25%) studies were identified as level 4, and one article (3.12%) was not identified as any level, as there is no mention of the qualitative method in JBI Levels of Evidence [44].See Table 1.

Data Extraction
Following the search, all identified citations were systematically organised and uploaded to the bibliographic management software MendeleyCite©2022.Subsequently, these records were imported into the online systematic review tool Rayyan©2022.In this phase, researcher author R.A.M. led the process by meticulously excluding duplicate documents and articles with incorrect publication dates or those not meeting the specified study design criteria.
Following this initial curation, the titles and abstracts of the remaining articles were reviewed by researchers R.A.M. and S.A.M. to assess their alignment with the predefined inclusion criteria.Concurrently, researchers M.L.P. and A.S.S. verified the excluded studies to ensure the appropriateness of the exclusion criteria applied.
For the articles that passed the initial screening, the full text was carefully assessed against the inclusion criteria by researchers N.B.G., S.A.M., and M.R.N., with responsibilities shared equally.To ensure data integrity, approximately 20% of each author's extractions were randomly cross-checked.
Any disagreements that arose during the various stages of the selection process were resolved through consultation with an additional reviewer.The search results and the process of study inclusion were reported following the PRISMA-ScR guidelines for updated scoping reviews [40].
To extract the studies included in the review, a Microsoft Excel table (Microsoft Corp., Redmond, WA, USA) was employed.This enabled the systematic tabulation and categorisation of the gathered information based on the review's objectives, encompassing details such as publication title, author, country, year, study type, the age group of the studied population, the purpose of telehealth utilisation, the role of nursing, as well as the benefits and limitations identified in the development of the intervention, including any interventions related to the COVID-19 pandemic.The data extraction tool was continuously reviewed and adjusted to enhance accuracy and consistency.

Analysis and Synthesis of Data
The analysis was conducted using Microsoft Excel and SPSS software (version 26.0;IBM Corp., Armonk, NY, USA).We employed descriptive statistics, focusing on frequencies and proportions, to synthesise the gathered data.

Search Outcomes
The search strategy resulted in 518 publications; after excluding duplicates, which were screened by title according to the eligibility criteria, 391 articles remained.They were further filtered by abstract, resulting in 95 articles.After the full-text review of these remaining articles, sixteen were rejected due to failed retrieval and one relevant article from the grey literature was included.Thirty-two reports remained for the final review.Reasons for exclusion of full text were as follows: design (n = 8); no telehealth (n = 5); wrong context (n = 8); out of age range (n = 13), parent/adult study (n = 12); duplicate article (n = 2).The PRISMA flow diagram of the study selection process is shown in Figure 1.

Characteristics of Studies
Among the 32 articles incorporated into this review, the studies exhibited a diverse array of characteristics.Notably, fifteen (46.87%) studies employed a randomised controlled trial (RCT) design, two studies employed a prospective experimental design , while three (9.37%)adopted a quasi-experimental design, including one pre-post design (3.12%) and two (6.25%) studies using a prospective evaluation methodology.An additional three (9.37%)studies were categorised as observational analytical studies.A total of eight (25%) studies were classified as descriptive observational studies, including cross-sectional study (1), case series (2), individual case report (1), and not specified (4).Lastly, one (3.12%)study employed a qualitative methodology.
Regarding the age of participants, twelve (37.50%) studies were centred on children aged 6 to 12 years, while nine (28.12%) studies focused on adolescents aged 13 to 18 years.Notably, 11 (34.37%)studies encompassed interventions targeting both age ranges.
The geographical distribution of these studies showcased a diverse landscape, with eleven (34.37%) studies originating from the United States, five (15.62%) from Australia, four (12.5%) from the United Kingdom, and six (18.75%) conducted in Canada, Sweden, and the Netherlands.Additionally, the countries in which single studies were carried out were Bangladesh, New Zealand, Greece, Honk Kong, Poland, and South Africa.Most articles were published in high-income countries according to the WHO regional classifica-

Characteristics of Studies
Among the 32 articles incorporated into this review, the studies exhibited a diverse array of characteristics.Notably, fifteen (46.87%) studies employed a randomised controlled trial (RCT) design, two studies employed a prospective experimental design, while three (9.37%)adopted a quasi-experimental design, including one pre-post design (3.12%) and two (6.25%) studies using a prospective evaluation methodology.An additional three (9.37%)studies were categorised as observational analytical studies.A total of eight (25%) studies were classified as descriptive observational studies, including cross-sectional study (1), case series (2), individual case report (1), and not specified (4).Lastly, one (3.12%)study employed a qualitative methodology.
Regarding the age of participants, twelve (37.50%) studies were centred on children aged 6 to 12 years, while nine (28.12%) studies focused on adolescents aged 13 to 18 years.Notably, 11 (34.37%)studies encompassed interventions targeting both age ranges.
The geographical distribution of these studies showcased a diverse landscape, with eleven (34.37%) studies originating from the United States, five (15.62%) from Australia, four (12.5%) from the United Kingdom, and six (18.75%) conducted in Canada, Sweden, and the Netherlands.Additionally, the countries in which single studies were carried out were Bangladesh, New Zealand, Greece, Honk Kong, Poland, and South Africa.Most articles were published in high-income countries according to the WHO regional classification (83.33%).
To address the research questions effectively, the results were thoughtfully categorised into three categories: (a) the purpose of telehealth and intervention strategies, (b) the role of nursing in school-based telehealth practice, and (c) perceived benefits and limitations of school-based telehealth studies.Furthermore, it is noteworthy that nurses played a pivotal role in the interventions in eight (25%) of the studies, with two studies contextualised explicitly within the framework of the COVID-19 pandemic.These studies provided valuable insights into how telehealth was adapted and leveraged to address the unique needs of students and their families during this extraordinary period, as detailed in Table 1.
No specific interventions directly related to the COVID-19 pandemic were identified, although one study claimed that the pandemic prompted the telehealth intervention [46], and another study was conducted during the pandemic [45].
Additionally, no interventions were specifically designed for special education (refer to Table 2 for a concise summary of these findings).

Nursing role
Administration and monitoring of medical guidelines via teleconsultation; scheduling and monitoring of telemedicine visits; facilitating fluid communication in virtual visits; and mediating between different agents (family, teachers, paediatricians, and students).

(9.37%)
Motivational interviews through teleconsultation on specific risk areas and mental health; behavioural assessment in the detection of psychosocial problems via YouthCHAT.

(6.25%)
Comprehensive asthma education aimed at crisis prevention; evaluation and treatment of asthma crises; coordination with the primary care team for the application of the hearing problems detection programme; follow-up through telemedicine; and coordination and execution of anthropometric tests for the detection of metabolic syndrome.

(9.37%)
N (%): number of articles reported (percentage).Percentage calculated on the total of articles included in the review (N = 32).

Role of Nursing in School-Based Telehealth Practice
In this review, nursing played a vital role in 25% of the telehealth interventions, while in the rest of the articles, the role of nurses was not reported, as it was mostly a paediatric medical team who developed the interventions.The nursing interventions highlighted in this context encompassed the following: -Administration and monitoring of medical guidelines via teleconsultation to ensure efficient completion; support to school staff; and scheduling and monitoring attendance of telemedicine visits in the prevention and diagnosis of asthma [50,71].In addition, the nurses helped ensure seamless communication with the physician during virtual visits; served as guardians of students' health information; and operated as the primary interface between parents, students, paediatricians, and teachers on school health issues [67]; -Motivational interviews with adolescents through teleconsultation focusing on specific risk areas and mental health in particular [75].Behavioural assessment analysed in opportunistic screening for psychosocial problems through YouthCHAT [56]; -Finally, nurses collaborated by conducting educational interventions via telemedicine and conducting comprehensive asthma education aimed at preventing crises, as well as assessing treatment efficacy and monitoring crises via teleconsultation [69].In the detection and follow-up of hearing problems, they coordinated with primary care staff in the implementation of the Tele-Health-Kids (THK) programme and collaborated in follow-ups via telemedicine [74].They coordinated and executed the biochemical analyses (blood draw) and anthropometric tests for metabolic syndrome screening via telemedicine [58].
For detailed information on these nursing interventions, please refer to Table 2.

Perceived Benefits and Limitations of School-Based Telehealth Studies
The integration of digital tools into educational settings has demonstrated many benefits in improving students' heath.The studies included in this review highlighted various advantages, such as the following: Complementing traditional interventions: Digital tools were found to complement traditional health interventions, leading to improved health outcomes and better control of problems such as anxiety [45,52], oral pathology [62], asthma [50], speech and language problems [60], and hearing problems [72].They also proved effective as a screening method for hearing problems [66], resulting in fewer symptoms, better health problem management, and reduced readmissions and visits to the respiratory emergency department [67]; Enhanced clinical care and family cooperation: Some authors reported superior clinical care and increased cooperation with families [61,74].Children actively engaged in their health [55,62,76], promoting a positive public health impact [71].In addition, remote care enabled improved monitoring of health problems in rural communities with difficult access to health services and immigrant populations with language difficulties [46,47,65,70]; Knowledge and skill acquisition: Digital tools facilitated the acquisition of knowledge, skills, and positive health attitudes [49,54] They were also instrumental in reducing or preventing risk behaviours, including unintended pregnancy [63], photoaging [64], and smoking cessation [57].In some instances, they resulted in cost savings within the US healthcare system, known for its free market care model [59], and in healthcare system in general [56,68].Additionally, they served as an information system for nurses regarding the health status of vulnerable school children, enhancing face-to-face consultations [75]; Unclear or insignificant outcomes: However, it is worth noting that in four of the included studies, the benefits of the outcomes were unclear or showed no significant change [53,58,69,73].
Despite these substantial benefits, there were several limitations observed in the practice of school-based telehealth: Study design limitations: Some limitations were inherent to the study designs, which might have led to contamination between participant groups, information bias, carry-over effect, or challenges in instrument validation [51,60,66]; Limited generalisation: Many studies had limitations related to sample size and short trial durations, making it challenging to generalise their findings beyond the studied context [45,46,48,[54][55][56][57][58][59]61,63,64,67,68,74,75]; Digital literacy and access: Limited digital literacy among students, families, teachers, and healthcare workers was identified as a challenge [51], along with restricted access to mobile phones in some territories [76].Technical difficulties and limited resources were a barrier in various studies [49,50,55,70].Implementation costs and the need for government confidence in the strategy were also recognised [71]; Other limitations: Finally, other limitations included lack of participation in the programme [52, 53,69,72] and concerns regarding data confidentiality [63].
Notably, two reviewed articles reported no limitations [47,65].These findings demonstrate the potential of school-based telehealth, underscoring the importance of addressing associated challenges and limitations.

Discussion
The scoping review of 32 studies conducted to examine the current breadth and range of research on nurses' use of telehealth interventions in school settings over the past decade has revealed several crucial insights.
First, these interventions have as their primary objective the promotion of healthy lifestyle habits and enable the early identification and management of various health problems in different age groups [77].Within this realm, mental health has become a critical concern that can be effectively addressed in the school setting using telehealth.This focus aligns with the World Health Organisation's recent prioritisation of emotional well-being and health in children and adolescents, particularly pertinent given that one in seven children and adolescents suffers from a mental disorder.This concern has been further compounded by the challenges imposed by the COVID-19 pandemic [78,79].
A critical area highlighted in our review concerns the management of chronic diseases such as asthma and addressing speciality care issues, such as hearing loss, through telehealth.Studies have shown that regular communication facilitated by telehealth tools such as video conferencing, mobile telephones, and patient portals significantly helps manage chronic childhood diseases such as asthma [80][81][82].Noteworthy is the role of school nurses, who are critical in coordinating healthcare and education through telehealth [83].Their participation ensures effective follow-up by primary and speciality care providers, reducing fragmented care and unnecessary medical services [84,85].
Despite the apparent value of telehealth during the COVID-19 pandemic, there remains a dearth of research on telehealth in schools [86,87].The challenge is to conduct primary studies with comprehensive data, especially when schools remain closed.
Regarding the strategies used, various telehealth methods have been reported, including teleconsultation through videoconferencing, telediagnosis, telemonitoring through portable devices, and tele-education through digital tools or mHealth for health promotion and the prevention of risk behaviours.Although specific information on the most effective telehealth strategies in schools remains limited, some studies suggest that mHealth appeals to children and adolescents due to its ease of access to health information and services [88][89][90].Other authors highlight the effectiveness of paediatric teleconsultation, enabling flexibility in terms of space and scheduling, time savings, and prevention of self-diagnosis and self-medication [91,92].
Overall, there is consensus among researchers that telehealth holds significant potential to improve health outcomes for children and adolescents [93].Moreover, the National Association of School Nurses (NASN) recognises telehealth as an alternative delivery model.It underscores its potential to enhance the impact of school nurses on student health and academic outcomes [94].
It is worth noting that our review identified limited research regarding the utilisation of artificial intelligence (AI) in the school environment and telehealth practice.However, some researchers have highlighted the advantages of AI in this domain, such as identifying health patterns, providing valuable health information, and enabling professionals to make more informed and accurate decisions [95,96].The future applications of AI in school-based telehealth practice promise further advancements.
In summary, our findings emphasise the significant role of nurses in telehealth, offering essential remote healthcare and enhancing school students' access to healthcare services.Nurses play a collaborative and proactive role, working closely with physicians and other healthcare professionals.However, it is noteworthy that, according to our review, nurses tend to prefer preventive and health promotion activities over providing care during acute exacerbations.This preference aligns with other authors who underscore the fundamental role of nurses in simplifying access to and utilisation of telemedicine services [97].
Furthermore, nurses facilitate education and follow-up with other healthcare services for schoolchildren with special health needs, particularly during the COVID-19 pandemic, particularly in underserved or geographically challenging communities within the school context [98,99].It is essential to acknowledge that nurses have also led telehealth interventions beyond the school setting [100][101][102].
In our exploration of school-based telehealth, we encountered limited evidence about the role of nursing within school settings.This necessitated a reevaluation of our search methodology, prompting a strategic shift towards interventions led or actively participated in by nurses.Moreover, within the array of included studies, the benefits of the outcomes were occasionally indistinct or exhibited no significant changes in specific instances [53,58,69,73].Some studies revealed inherent limitations tied to study designs, information bias, or challenges in instrument validation [51,60,66].Furthermore, several studies grappled with constraints related to sample size and the brief duration of trials, posing challenges in generalising their findings [45,46,48,[54][55][56][57][58][59]61,63,64,67,68,74,75].
In summary, while our exploration sheds light on the potential of school-based telehealth, it also underscores critical evidence gaps and methodological limitations that warrant careful consideration in shaping future research endeavours in this evolving field.

Limitations and Strengths
This scoping review has several limitations which may have influenced the results obtained.We only included articles written in English or Spanish and with full text available, which could have led to the loss of some critical articles in this review.In addition, we performed the bibliographic search in three databases, and although these databases are highly recommended according to JBI methodology for scoping reviews, relevant sources of information may, however, have been omitted, and the review question depends on what information is available.Thus, the study's main limitation was challenges in delineating the role of nursing in the context of telehealth within school settings.While we recognise their involvement, limited evidence led us to reevaluate our search methodology, focusing on interventions led by nurses or those in which they actively participated.
Categorising articles by intended age ranges posed another limitation.Initially, we planned to divide articles into two age groups: 6-12 years and 13-18 years.However, due to the variability in age ranges covered in the articles, we chose to conduct separate analyses for studies encompassing both age groups, ultimately considering the age range of 6-18 years to examine the available information and optimise overall results comprehensively.
Despite the limitations mentioned above, this study presents strengths to be taken into account.Our study is based on a comprehensive scoping review that includes a wide range of sources and a substantial number of studies, which provides a thorough overview of the subject matter.
We followed established guidelines and checklists, such as the Joanna Brigs Institute Reviewer's Manual and the PRSMA-ScR checklist, to ensure the quality and transparency of our review.
The selection and data extraction stages were conducted with the active participation of at least two independent reviewers, enhancing the reliability and rigor of the study.
In summary, while our study offers a comprehensive overview of the subject, these strengths and limitations should be taken into consideration when interpreting our findings and framing future research in this area.

Implications of Findings
Indeed, there are implications for practice, research, and policy based on the study's findings, which are as follows.

Implications for Practice
Enhanced access to healthcare: This study highlights the potential for improved access to healthcare through virtual consultations in school settings.Students can readily receive advice, diagnoses, and health monitoring, which is especially beneficial in remote geographic areas where traditional healthcare access may be limited; Early detection of health problems: Telehealth offers a valuable tool for detecting various health issues, including visual, hearing, developmental, or emotional disorders.This early identification can lead to timely interventions and support for students; Health promotion and disease management: Nurses play a crucial role in telehealth by providing information on healthy habits, disease prevention, and the management of chronic conditions.This empowers students to adopt a healthier lifestyle and take control of their well-being.

Implications for Research
Exploring artificial intelligence (AI) applications: This study opens the door for future research into integrating AI into healthcare within educational settings.Investigating how AI can enhance the delivery of healthcare and support students' health and well-being is a promising avenue for further inquiry.

Implications for Policy
Integrating telehealth into school healthcare: Policymakers should take note of the potential of telehealth in school settings.This study can catalyse and encourage the adoption of measures that incorporate telehealth into educational institutions, ensuring that students receive comprehensive care and support.Active leadership of nurses: Policymakers should also consider measures that encourage operational leadership by nurses in telehealth initiatives within schools.Collaborative efforts involving all relevant stakeholders, including educational institutions, healthcare providers, and government bodies, can ensure the effective implementation of telehealth.

Conclusions
In conclusion, this scoping review delves into a decade of telehealth practices in school settings, spotlighting the integral role of nursing professionals.Of 32 studies, 15 adopted robust randomised controlled trial designs, focusing on themes like auditory screening, mental health promotion, and respiratory management.
The age-centric approach encompassed children (6-12 years) and adolescents (13-18 years), reflecting a global distribution of studies.The results, categorised into telehealth purpose, nursing role, and perceived outcomes, highlighted nurses' critical involvement in 25% of interventions across diverse health domains.
The perceived benefits derived from these interventions were substantial, augmenting traditional approaches, enhancing clinical care, and fostering collaborative efforts within families.
The implications underscored the enhancement of healthcare access, early anomaly detection, and the elevation of nursing leadership within the telehealth domain.
These findings seamlessly align with the review's objectives, underscoring the pivotal role of telehealth in schools.While progress has been made, ongoing exploration and a reinforced emphasis on nursing leadership remain imperative in this dynamic landscape.
In this context, the challenges and opportunities observed in school nursing practice present promising avenues for future research-focusing on leadership and innovation to cultivate healthier, digitally inclusive educational environments.
Informed Consent Statement: Not applicable.

Healthcare 2023, 11, x 15 of 26 Figure 1 .
Figure 1.PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers, and other sources, adapted from [40].

Figure 1 .
Figure 1.PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers, and other sources, adapted from [40].

Table 1 .
Main results of the included studies.

Table 2 .
Purpose of telehealth, intervention strategies, and role of nursing in school-based telehealth practices.