Sense of School Belonging and School Reintegration for Students Hospitalized With Chronic or Complex Medical Diseases: Insights From a Grounded Theory Study

Limited attention has been devoted to how hospitalized students maintain connections with their school communities.

“Despite extensive research on academic and emotional outcomes of pediatric illness [42], limited attention has been devoted to how hospitalized students maintain connections with their school communities, and few studies integrate children's voices alongside those of parents and teachers [43].”

• cites [42] S. Pini, S. Hugh‐Jones, and P. H. Gardner, “ What Effect Does a Cancer Diagnosis Have on the Educational Engagement and School Life of Teenagers? A Systematic Review,” Psycho‐Oncology 21, no. 7 (2012): 685– 694, 10.1002/pon.2082. 22006640 sourcePartly supported

  The Introduction (p. 3) says research on educational engagement among teenagers with cancer has focused on specific aspects and that no systematic review had examined their sustained engagement with school and its community. This supports a research gap, but the paper does not establish that limited attention has been paid to how hospitalized students generally maintain those connections. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Growing evidence identifies SoSB as a facilitator of well-being and academic and psychological outcomes among students with chronic illness.

“Growing evidence identifies SoSB as a facilitator of well‐being and academic and psychological outcomes among students with chronic illness [32, 36, 37, 38, 39].”

• cites [32] B. K. C. Spencer, S. Hugh‐Jones, D. Cottrell, and S. Pini, “ The INSCHOOL Project: Young People With Long‐Term Physical Health Conditions: An In‐Depth Qualitative Study of Their Needs at School,” Journal of Adolescence 96, no. 2 (2024): 337– 349, 10.1002/jad.12278. 38013246 sourceSupported
• cites [36] V. Baskaran, L. A. Chubb, and C. B. Fouché, “ Keeping Students With Long‐Term Conditions Connected With Schools: Facilitators for Sustainable Virtual Connections,” Continuity in Education 5, no. 1 (2024): 111– 127, 10.5334/cie.133. 39310275 PMC11414465 sourceSupported
• cites [37] E. Ciucci, C. Facci, D. Carpenzano, et al., “ Promoting Teachers' Social and Emotional Competence in Light of the Close Connection Between Professional Role and Personal Characteristics: Preliminary Evidence of the Efficacy of the “ME4YOU” Training Program,” IJERPH 21, no. 4 (2024): 511, 10.3390/ijerph21040511. 38673422 PMC11050115 sourceCould not verify

  The Introduction and Discussion address teachers’ social and emotional competence and its possible effects on students, but do not address sense of school belonging (SoSB) among students with chronic illness. Searches for “SoSB,” “chronic illness,” and the claimed academic and psychological outcomes found no passage supporting that point. (LLM, conf=0.75)

  Experimental — accuracy not yet measured
• cites [38] M. Weibel, S. Skoubo, C. Handberg, et al., “ Telepresence Robots to Reduce School Absenteeism Among Children With Cancer, Neuromuscular Diseases, or Anxiety—The Expectations of Children and Teachers: A Qualitative Study in Denmark,” Computers in Human Behavior Reports 10 (2023): 100280, 10.1016/j.chbr.2023.100280. sourceNot checked — no full text of the source
• cites [39] C. Zillner, G. Rockenbauer, A. Turner, M. Röhsner, K. Klebermass‐Schrehof, and T. Pletschko, “ Maintaining Health‐Related Quality of Life and Sense of Belonging for Pediatric Patients With Chronic Illnesses by Using a Telepresence Robot,” Journal of Child Health Care 30, no. 1 (2026): 23– 35, 10.1177/13674935241301819. 39570190 sourceNot checked — no full text of the source

Prolonged absence and limited communication may undermine sense of belonging.

“whereas prolonged absence and limited communication may undermine sense of belonging [20, 29, 30, 31, 32].”

• cites [20] L. Tomberli and E. Ciucci, “ Sense of School Belonging and Paediatric Illness: A Scoping Review,” Continuity in Education 2, no. 1 (2021): 121– 134, 10.5334/cie.32. 38774888 PMC11104300 sourceSupported
• cites [29] K. A. Allen, C. D. Slaten, G. Arslan, S. Roffey, H. Craig, and D. A. Vella‐Brodrick, “ School Belonging: The Importance of Student and Teacher Relationships,” in The Palgrave Handbook of Positive Education, ed. M. L. Kern and M. L. Wehmeyer (Springer International Publishing, 2021), 525– 550, 10.1007/978-3-030-64537-3_21. sourcePartly supported

  The Relationships Matter section says opportunities to connect and positive interactions are important to belonging, which supports the point about limited communication in broad terms. The Current Context section also links student–teacher relationships to school belonging. Neither section addresses whether prolonged absence undermines belonging; searches for absence and communication found no more specific passage. Page numbers were not available in our copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites [30] M. Capurso, V. Moracci, and S. Borsci, “ Pathways to School Reentry for Children and Young People With a Medical or Mental Health Condition: An International Delphi Study,” Continuing Education 6, no. 1 (2025): 38– 57, 10.5334/cie.159. PMC11887473 40061057 sourcePartly supported

  The paper’s introductory discussion (indexed under Abstract; page unavailable) says school absences disrupt social interactions and can leave learners feeling isolated and alienated from their school community. It also emphasizes communication in reentry planning, but does not link limited communication specifically to a diminished sense of belonging. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [31] A. Lewandowska, B. Zych, K. Papp, et al., “ Problems, Stressors and Needs of Children and Adolescents With Cancer,” Children 8, no. 12 (2021): 1173, 10.3390/children8121173. 34943367 PMC8700549 sourcePartly supported

  The Results (sections 4.2 and 4.3; page unavailable) report infrequent peer contact, communication problems associated with isolation, and isolation as a factor negatively affecting well-being. The Discussion also describes adverse effects of time away from school. The paper does not specifically assess sense of belonging or establish that prolonged absence and limited communication undermine it. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [32] B. K. C. Spencer, S. Hugh‐Jones, D. Cottrell, and S. Pini, “ The INSCHOOL Project: Young People With Long‐Term Physical Health Conditions: An In‐Depth Qualitative Study of Their Needs at School,” Journal of Adolescence 96, no. 2 (2024): 337– 349, 10.1002/jad.12278. 38013246 sourceSupported

Few studies integrate children's voices alongside those of parents and teachers.

“Despite extensive research on academic and emotional outcomes of pediatric illness [42], limited attention has been devoted to how hospitalized students maintain connections with their school communities, and few studies integrate children's voices alongside those of parents and teachers [43].”

• cites [43] D. Maor, K. Mitchem, and R. Drewry, “ The Art of Coaching: Addressing Mobile Technology Integration in a Complex Hospital School Environment,” Continuity in Education 1, no. 1 (2020): 83– 97, 10.5334/cie.15. 38774527 PMC11104320 sourceCould not verify

  The book-review section discusses school-related challenges and reintegration after absence, but does not assess how often studies include children’s voices alongside parents’ and teachers’. Searches for that claim and for hospitalized students’ school-community connections found no passage addressing the asserted research gap. Page numbers are not available in our copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

HBS functions as a symbolic bridge toward life beyond hospitalization.

“our findings demonstrate that HBS functions as a symbolic bridge toward life beyond hospitalization.”

• cites [59] E. Ciucci, L. Tomberli, E. Amore, A. Smorti, F. Maffei, and L. Vagnoli, “ The Effects of Hospital‐Based School Lessons on Children's Emotions, Distress and Pain,” Continuity in Education 5, no. 1 (2024): 100– 110, 10.5334/cie.118. 39036770 PMC11259103 sourceSupported
• cites [60] S. R. Shaw and P. C. McCabe, “ Hospital‐To‐School Transition for Children With Chronic Illness: Meeting the New Challenges of an Evolving Health Care System,” Psychology in the Schools 57, no. 7 (2020): 1040– 1052, 10.1002/pits.22368. sourceNot checked — no full text of the source

Close dyadic teacher-student bonds fostered resilience in medicalized environments.

“In line with attachment‐oriented perspectives, these bonds fostered resilience in medicalized environments [62, 63].”

• cites [62] M. Capurso, G. Catalano, A. Calvaruso, et al., “ Tailored Psychoeducational Home Interventions for Children With a Chronic Illness: Families and Experiences,” CiE 5, no. 1 (2024): 1– 21, 10.5334/cie.100. 38774596 PMC11104378 sourcePartly supported

  Results (Domain I) describes a child’s close relationship with home-care professionals, and the Conclusion says psychoeducational services can promote resilience at home. The paper does not establish that dyadic teacher–student bonds fostered resilience in medicalized environments; its focus is on children and families receiving home-based interventions. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [63] B. K. Hamre and R. C. Pianta, “ Can Instructional and Emotional Support in the First‐Grade Classroom Make a Difference for Children at Risk of School Failure?,” Child Development 76, no. 5 (2005): 949– 967, 10.1111/j.1467-8624.2005.00889.x. 16149994 sourceNot checked — no full text of the source

When continuity was lacking, students experienced isolation and anxiety about returning to school.

“When continuity was lacking, students experienced isolation and anxiety about returning to school [32].”

• cites [32] B. K. C. Spencer, S. Hugh‐Jones, D. Cottrell, and S. Pini, “ The INSCHOOL Project: Young People With Long‐Term Physical Health Conditions: An In‐Depth Qualitative Study of Their Needs at School,” Journal of Adolescence 96, no. 2 (2024): 337– 349, 10.1002/jad.12278. 38013246 sourcePartly supported

  Section 4.2.4 (page unavailable) reports that absences disrupted friendships and left some participants feeling excluded, supporting the isolation part of the claim. Section 4.2.5 describes anxiety about moving to new schools or year groups, but the paper does not link anxiety about returning after an absence specifically to a lack of continuity. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Psychological support emerged as essential during reintegration.

“Psychological support emerged as essential during reintegration, aligning with interdisciplinary and systemic models [30, 75, 76].”

• cites [30] M. Capurso, V. Moracci, and S. Borsci, “ Pathways to School Reentry for Children and Young People With a Medical or Mental Health Condition: An International Delphi Study,” Continuing Education 6, no. 1 (2025): 38– 57, 10.5334/cie.159. PMC11887473 40061057 sourceSupported
• cites [75] R. M. Yilmaz, F. B. Topu, and Y. Goktas, “ Using Mobile Technologies in Hospital Classrooms: Effects on Student Engagement and Learning,” Computers in Education 79 (2014): 87– 96, 10.1016/j.compedu.2014.07.009. sourceNot checked — no full text of the source
• cites [76] C. J. Kaffenberger, “ School Reentry for Students With a Chronic Illness: A Role for Professional School Counselors,” Professional School Counseling 16, no. 1 (2012): 1– 10.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Parents experienced emotional relief.

“School was increasingly viewed not only as a place for academic achievement but also as a relational and developmental space, with parents experiencing emotional relief and teachers recognizing the importance of relationships alongside learning.”

HBS helps preserve children's identity as students.

“HBS was also reported to promote children's autonomy and emotional separation from parents during hospitalization, helping preserve their identity as students.”

HBS supports healthy aspects of identity development through everyday activities, personal growth, and life skills beyond academic learning.

“Hospital teachers emphasized that HBS helps students feel less isolated and more “equal to their peers,” while supporting healthy aspects of identity development through everyday activities, personal growth, and life skills beyond academic learning.”

Teachers recognized the importance of relationships alongside learning.

“School was increasingly viewed not only as a place for academic achievement but also as a relational and developmental space, with parents experiencing emotional relief and teachers recognizing the importance of relationships alongside learning.”

Drawings of the hospital school context focused exclusively on the dyadic teacher-student relationship, with no peers represented.

“Notably, drawings of the hospital school context focused exclusively on the dyadic teacher–student relationship, with no peers represented.”

Communication mediated by hospital school coordinators or support services often generated feelings of distance and lack of communication and institutional support, particularly at the secondary school level.

“Mainstream teachers described communication with the HBS as largely mediated by hospital school coordinators or support services, which often generated feelings of distance and lack of communication and institutional support, particularly at the secondary school level where teacher–student contact is more limited.”

Some hospital teachers reported that hospitalized students were sometimes forgotten by mainstream schools, especially when staff changes occurred.

“In contrast, hospital teachers perceived limited engagement from mainstream teachers in maintaining school–hospital connections, with some reporting that hospitalized students were sometimes forgotten by mainstream schools, especially when staff changes occurred.”

School psychologists emerged as key figures in guiding teachers and facilitating reintegration processes.

“In this context, school psychologists emerged as key figures in guiding teachers and facilitating reintegration processes, reinforcing the idea that students remain active members of their school communities throughout hospitalization.”

The hospital school can provide a sense of normalcy.

“The data highlighted how the hospital school (HBS) can foster future orientation, provide a sense of normalcy, act as a distraction from illness, and maintain connections with the student's mainstream school (MS).”

Several teachers described uncertainty and fear of intrusiveness, which often resulted in inaction when a student was hospitalized.

“Several teachers described uncertainty and fear of intrusiveness, which often resulted in inaction when a student was hospitalized.”

The hospital school can act as a distraction from illness.

“The data highlighted how the hospital school (HBS) can foster future orientation, provide a sense of normalcy, act as a distraction from illness, and maintain connections with the student's mainstream school (MS).”

The hospital school can maintain connections with the student's mainstream school.

“The data highlighted how the hospital school (HBS) can foster future orientation, provide a sense of normalcy, act as a distraction from illness, and maintain connections with the student's mainstream school (MS).”

HBS promotes continuity in education.

“Overall, HBS was described by parents and teachers as promoting continuity in education and facilitating smoother school reintegration.”

HBS facilitates smoother school reintegration.

“Overall, HBS was described by parents and teachers as promoting continuity in education and facilitating smoother school reintegration.”

The relationship between students and hospital schoolteachers differs substantially from that in mainstream schools, primarily due to the one-to-one interaction characteristic of the hospital setting.

“The findings showed that the relationship between students and hospital schoolteachers differs substantially from that in mainstream schools, primarily due to the one‐to‐one interaction characteristic of the hospital setting.”

School was increasingly viewed not only as a place for academic achievement but also as a relational and developmental space.

“School was increasingly viewed not only as a place for academic achievement but also as a relational and developmental space, with parents experiencing emotional relief and teachers recognizing the importance of relationships alongside learning.”

Mainstream teachers described communication with the HBS as largely mediated by hospital school coordinators or support services.

“Mainstream teachers described communication with the HBS as largely mediated by hospital school coordinators or support services, which often generated feelings of distance and lack of communication and institutional support, particularly at the secondary school level where teacher–student contact is more limited.”

The hospital school can foster future orientation.

“The data highlighted how the hospital school (HBS) can foster future orientation, provide a sense of normalcy, act as a distraction from illness, and maintain connections with the student's mainstream school (MS).”

Both groups identified a shared challenge in the absence of adequate training to manage school-hospital coordination and foster school belonging.

“Both groups identified a shared challenge in the absence of adequate training to manage school–hospital coordination and foster school belonging.”

The hospital context appears to facilitate the development of a strong emotional bond with hospital teachers across all participant groups.

“While mainstream teachers typically engage with entire classes and have fewer opportunities for dyadic relationships, the hospital context appears to facilitate the development of a strong emotional bond with hospital teachers across all participant groups.”

Hospital teachers perceived limited engagement from mainstream teachers in maintaining school-hospital connections.

“In contrast, hospital teachers perceived limited engagement from mainstream teachers in maintaining school–hospital connections, with some reporting that hospitalized students were sometimes forgotten by mainstream schools, especially when staff changes occurred.”

Participation in HBS contributed to a broader reframing of the meaning of school among both parents and teachers.

“Finally, participation in HBS contributed to a broader reframing of the meaning of school among both parents and teachers.”

Formal exchanges (e.g., remote lessons) emerged as protective factors.

“Both formal (e.g., remote lessons) and informal (e.g., messages, drawings) exchanges, along with psychologists and associations, emerged as protective factors.”

Mainstream schools often struggled to address students' relational needs alongside educational plans.

“Hospital teachers further noted that mainstream schools often struggled to address students' relational needs alongside educational plans.”

Many hospital teachers reported they learn primarily through experience rather than formal preparation.

“In contrast, hospital teachers strongly emphasized the importance of specialized training, although many reported they learn primarily through experience rather than formal preparation.”

Students felt forgotten by their mainstream schools.

“Students reported strong emotional bonds with hospital teachers but felt forgotten by their mainstream schools.”

Mainstream teachers often reported feeling unprepared to manage the complexities of students' illnesses, promote inclusion, and prevent school dropout during medical absence.

“The findings revealed substantial gaps in the training of mainstream teachers, who often reported feeling unprepared to manage the complexities of students' illnesses, promote inclusion, and prevent school dropout during medical absence.”

Hospital teachers emphasized that the specific temporal and spatial constraints of the hospital context require tailored teaching approaches.

“Hospital teachers emphasized that the specific temporal and spatial constraints of the hospital context require tailored teaching approaches, while mainstream teachers perceived differences between hospital and mainstream teaching methods as creating a disconnect in students' educational experiences and complicating their return to school.”

Some children avoided drawing their mainstream school, describing sadness for missing classmates.

“Some children avoided drawing their mainstream school, describing sadness for missing classmates.”

Associations emerged as protective factors.

“Both formal (e.g., remote lessons) and informal (e.g., messages, drawings) exchanges, along with psychologists and associations, emerged as protective factors.”

Some students avoided drawing their mainstream school due to sadness linked to feeling forgotten.

“Parents particularly described challenges in maintaining communication with teachers, especially at the middle school level, while some students avoided drawing their mainstream school due to sadness linked to feeling forgotten.”

Informal exchanges (e.g., messages, drawings) emerged as protective factors.

“Both formal (e.g., remote lessons) and informal (e.g., messages, drawings) exchanges, along with psychologists and associations, emerged as protective factors.”

Hospitalized students often felt forgotten by their schoolmates.

“This experience was echoed by parents and teachers, who reported that hospitalized students often felt forgotten by their schoolmates.”

Professional development opportunities have increased over time.

“While professional development opportunities have increased over time, training remains non‐mandatory and most effective when delivered by professionals with in‐depth knowledge of the HBS context.”

Both hospital and mainstream teachers emphasized the central role of psychological support in reintegration, particularly during students' return to school.

“Both hospital and mainstream teachers emphasized the central role of psychological support in reintegration, particularly during students' return to school, which was described as one of the most challenging phases of the illness trajectory.”

The hospital context posed major challenges for implementing collective learning experiences.

“At the same time, the hospital context posed major challenges for implementing collective learning experiences.”

Information was frequently shared spontaneously through informal channels such as informal conversations or messaging apps, making it difficult to control or structure.

“Information was frequently shared spontaneously through informal channels such as informal conversations or messaging apps, making it difficult to control or structure.”

Differences in students' ages, curricula, and length of hospitalization made sustained group teaching difficult in hospital school.

“Limits of group activities in hospital school were reported by hospital teachers, who explained that differences in students' ages, curricula, and length of hospitalization made sustained group teaching difficult, in contrast to mainstream schools where classes share long‐term peer relationships and collective experiences.”

When peer contact occurred, it was often spontaneous and student-started.

“When peer contact occurred, it was often spontaneous and student‐started.”

The involved association highlighted the central role of teacher training and network-building among school, family, and hospital in fostering school belonging.

“Finally, the involved association highlighted the central role of teacher training and network‐building among school, family, and hospital in fostering school belonging.”

The absence of organized programs supporting reintegration in both formal and informal school contexts further intensified these challenges.

“The absence of organized programs supporting reintegration in both formal and informal school contexts further intensified these challenges.”

Hospital teachers strongly emphasized the importance of specialized training.

“In contrast, hospital teachers strongly emphasized the importance of specialized training, although many reported they learn primarily through experience rather than formal preparation.”

Children's drawings and narratives reflected emotional distress and feelings of disconnection from their schools.

“These difficulties were confirmed by hospital teachers, parents, and students, with children's drawings and narratives reflecting emotional distress and feelings of disconnection from their schools.”

The findings revealed substantial gaps in the training of mainstream teachers.

“The findings revealed substantial gaps in the training of mainstream teachers, who often reported feeling unprepared to manage the complexities of students' illnesses, promote inclusion, and prevent school dropout during medical absence.”

In secondary school, responsibility for maintaining relationships was often left to informal peer interactions.

“Teachers also reported difficulties in maintaining structured relationships between hospitalized students and their classmates, especially in secondary school, where this responsibility was often left to informal peer interactions.”

Distance learning reinforced misconceptions among mainstream teachers, who sometimes assumed that HBS was no longer necessary.

“Distance learning reinforced misconceptions among mainstream teachers, who sometimes assumed that HBS was no longer necessary, reflecting the perceived limits of distance learning for maintaining meaningful school–hospital connections.”

Psychologists emerged as protective factors.

“Both formal (e.g., remote lessons) and informal (e.g., messages, drawings) exchanges, along with psychologists and associations, emerged as protective factors.”

Parents particularly described challenges in maintaining communication with teachers, especially at the middle school level.

“Parents particularly described challenges in maintaining communication with teachers, especially at the middle school level, while some students avoided drawing their mainstream school due to sadness linked to feeling forgotten.”

The pandemic experience revealed an emotional and professional burden on teachers, reducing time and resources for maintaining school-hospital connections.

“The pandemic experience also revealed the emotional and professional burden on teachers, reducing time and resources for maintaining school–hospital connections.”

Not all mainstream teachers perceived additional training as necessary, arguing that existing competencies in special pedagogy were sufficient.

“Despite these challenges, not all mainstream teachers perceived additional training as necessary, arguing that existing competencies in special pedagogy were sufficient.”

Students reported strong emotional bonds with hospital teachers.

“Students reported strong emotional bonds with hospital teachers but felt forgotten by their mainstream schools.”

Communication between mainstream teachers and hospitalized students was primarily maintained with parents or hospital teachers rather than directly with students.

“Although mainstream teachers frequently reported “being in contact” with hospitalized students, closer examination revealed that communication was primarily maintained with parents or hospital teachers rather than directly with students.”

In the pre-pandemic phase, difficulties were mainly attributed to poor internet connectivity and limited digital skills.

“In the pre‐pandemic phase, difficulties were mainly attributed to poor internet connectivity and limited digital skills.”

Children's drawings and interviews consistently portrayed the HBS as a highly relational context, primarily focused on the dyadic teacher-student relationship rather than on peer interactions.

“Children's drawings and interviews consistently portrayed the HBS as a highly relational context, primarily focused on the dyadic teacher–student relationship rather than on peer interactions.”

Some students initially experienced a sense of normalcy during the pandemic, feeling part of a shared experience of isolation.

“Teachers reported that some students initially experienced a sense of normalcy during the pandemic, feeling part of a shared experience of isolation.”

Teachers reported difficulties in maintaining structured relationships between hospitalized students and their classmates, especially in secondary school.

“Teachers also reported difficulties in maintaining structured relationships between hospitalized students and their classmates, especially in secondary school, where this responsibility was often left to informal peer interactions.”

Teachers expressed concerns about the feasibility of involving psychologists in managing communication about a classmate's illness.

“At the same time, teachers expressed concerns about the feasibility of involving psychologists in managing communication about a classmate's illness.”

The relational dimension emerged as central for students' emotional experiences during hospitalization.

“Beyond organizational aspects, the relational dimension emerged as central for students' emotional experiences during hospitalization.”

Peer contact was limited.

“Peer contact was limited, and teachers felt unprepared to manage absences and reintegration.”

In children's drawings, mainstream schools were strongly associated with peer relationships, including both formal classroom moments and informal social interactions.

“In children's drawings, mainstream schools were strongly associated with peer relationships, including both formal classroom moments and informal social interactions.”

Many students, despite feeling welcomed upon return, did not fully regain their place within the ongoing class narrative they had been part of prior to hospitalization.

“the findings suggested that many students, despite feeling welcomed upon return, did not fully regain their place within the ongoing class narrative they had been part of prior to hospitalization.”

The role of HBS in fostering feelings of normalcy, equality, and emotional support was highlighted by parents and teachers.

“This perception aligned with reports from parents and teachers, who highlighted the role of HBS in fostering feelings of normalcy, equality, and emotional support.”

Students' return to school was described as one of the most challenging phases of the illness trajectory.

“Both hospital and mainstream teachers emphasized the central role of psychological support in reintegration, particularly during students' return to school, which was described as one of the most challenging phases of the illness trajectory.”

Parents and hospital schoolteachers described persistent difficulties in sustaining regular and informal school-hospital connections.

“This pattern was confirmed by parents and hospital schoolteachers, who described persistent difficulties in sustaining regular and informal school–hospital connections.”

The study identified only one local association specifically dedicated to preparing teachers and raising awareness about school inclusion for students with medical conditions.

“Although the association partially addressed training gaps, the study identified only one local association specifically dedicated to preparing teachers and raising awareness about school inclusion for students with medical conditions.”

Teachers felt unprepared to manage absences and reintegration.

“Peer contact was limited, and teachers felt unprepared to manage absences and reintegration.”

Post-pandemic teachers no longer viewed technology alone as adequate for fostering engagement and a sense of school belonging.

“While remote lessons were once considered sufficient to maintain connection, post‐pandemic teachers no longer viewed technology alone as adequate for fostering engagement and a sense of school belonging.”

Many students felt forgotten when there was no informal connection with schoolmates and mainstream teachers, even when educational continuity was ensured.

“Many students felt forgotten when there was no informal connection with schoolmates and mainstream teachers, even when educational continuity was ensured.”

Organizational differences between HBS and mainstream schools further complicated reintegration.

“Organizational differences between HBS and mainstream schools further complicated reintegration.”

Many teachers and staff felt unprepared to address students' medical and emotional needs.

“Targeted training for teachers and staff is crucial, as many felt unprepared to address students' medical and emotional needs.”

Fragmentation between hospital and mainstream schools emerged despite recognition of school belonging.

“Despite recognition of school belonging, fragmentation between hospital and mainstream schools emerged.”

Although digital technologies were viewed as potential bridges, their effectiveness proved limited when used alone.

“Although digital technologies were viewed as potential bridges, their effectiveness proved limited when used alone.”

Hospitalized students primarily experienced belonging through adult-child dyads with hospital teachers.

“hospitalized students primarily experienced belonging through adult–child dyads with hospital teachers, consistent with individualized pedagogy [68].”

• cites [68] C. Goodenow, “ Classroom Belonging Among Early Adolescent Students: Relationships to Motivation and Achievement,” Journal of Early Adolescence 13, no. 1 (1993): 21– 43, 10.1177/0272431693013001002. sourceNot checked — no full text of the source

Supportive school relationships are important in sustaining connection and reintegration.

“These relational dynamics highlighted the importance of supportive school relationships in sustaining connection and reintegration.”

Maintaining school connection during hospitalization is crucial for students' well-being and reintegration.

“Maintaining school connection during hospitalization is crucial for students' well‐being and reintegration [21].”

• cites [21] L. H. Lindgren, K. Schmiegelow, A. S. Helms, T. Thorsteinsson, and H. B. Larsen, “ In Sickness and in Health: Classmates Are Highly Motivated to Provide In‐Hospital Support During Childhood Cancer Therapy: In Sickness and in Health,” Psycho‐Oncology 26, no. 1 (2017): 37– 43, 10.1002/pon.4094. 26872002 sourceNot checked — no full text of the source

Students remain active members of their school communities throughout hospitalization.

“In this context, school psychologists emerged as key figures in guiding teachers and facilitating reintegration processes, reinforcing the idea that students remain active members of their school communities throughout hospitalization.”

HBS promoted personal growth and emotional autonomy through close dyadic teacher-student relationships.

“HBS also promoted personal growth and emotional autonomy through close dyadic teacher–student relationships.”

These experiences reflected the broader impact of COVID-19 on inclusion practices within hospital education.

“These experiences reflected the broader impact of COVID‐19 on inclusion practices within hospital education.”

Drawings of mainstream schools suggest a more impersonal representation of the school context.

“In contrast, drawings of mainstream schools often emphasized the physical classroom environment, such as desks and blackboards, and sometimes omitted both teachers and classmates, suggesting a more impersonal representation of the school context.”

Face-to-face presence and meaningful human relationships have an irreplaceable role in supporting hospitalized students.

“Importantly, it highlighted the irreplaceable role of face‐to‐face presence and meaningful human relationships in supporting hospitalized students.”

When active participation, involvement in the class narrative, and engagement with symbolic school elements are lacking, hospitalized students risk feeling abandoned, misunderstood, and emotionally disconnected from their schools.

“When these components are lacking, hospitalized students risk feeling abandoned, misunderstood, and emotionally disconnected from their schools.”

Maintaining educational continuity appeared insufficient to sustain a strong sense of school belonging.

“Overall, maintaining educational continuity appeared insufficient to sustain a strong sense of school belonging.”

The findings highlighted significant organizational differences between hospital schools and mainstream schools that may hinder reintegration processes.

“Overall, the findings highlighted significant organizational differences between hospital schools and mainstream schools that may hinder reintegration processes.”

Hospitalization disrupts students' connection with their school communities, placing their sense of school belonging at risk.

“Hospitalization disrupts students' connection with their school communities, placing their sense of school belonging at risk.”

These findings support concerns regarding digital-only solutions.

“These findings support concerns regarding digital‐only solutions [38].”

• cites [38] M. Weibel, S. Skoubo, C. Handberg, et al., “ Telepresence Robots to Reduce School Absenteeism Among Children With Cancer, Neuromuscular Diseases, or Anxiety—The Expectations of Children and Teachers: A Qualitative Study in Denmark,” Computers in Human Behavior Reports 10 (2023): 100280, 10.1016/j.chbr.2023.100280. sourceNot checked — no full text of the source