Conference Program

This contribution argues the prevailing confluence between educational relationship and care relationship within the hospital school, which makes the latter an educational community.

The latter, founded on the therapeutic alliance, implies the centrality of the person and, therefore, a multidisciplinary team aimed at the empowerment of the individual in fragile conditions. It is highlighted how, in the hospital school, caring also includes education and how the educational role is distributed among all those who collaborate towards an inclusive learning environment.

Thanks to the activity of the school-hospital network as educational community, it is possible to guarantee educational continuity avoiding the isolation of hospitalized students undergoing medical treatments, requiring prolonged hospitalization, and preserving the stability they need.

Hospital school represents a liminal educational context, characterized by radical vulnerability, temporal discontinuity, physical constraints, and a strong external direction of time and decisions. In such an environment, education is traditionally interpreted according to a compensatory logic, oriented towards curriculum maintenance and the prevention of dropout.

This contribution takes a pedagogical-social as well as didactic perspective and proposes a redefinition of hospital school as a privileged social laboratory of educational democracy and radical personalization of learning, transcending the deficit perspective and embracing the expression of talent as a universal educational right.

The central thesis is that, in healthcare contexts, agency cannot be considered a pre-existing resource of the student, but must be understood as a pedagogical outcome (passive healthcare vs. intentional and active educational care), intentionally constructed within conditions of dependence and vulnerability. In this sense, the semantics of the word “care” is redefined, as a new paradigm of social pedagogy, in its double meaning of “to cure” and “to care”, which recalls the double etymology of education as educare and ex-ducere.

The theoretical framework integrates critical pedagogy, the capability approach, the pedagogy of vulnerability, and Umberto Margiotta’s theory of education, reinterpreting agency as the subject’s epistemic positioning – that is, a stable internal disposition as a tendency to act actively and effectively in the real context, to transform it according to a project of improvement – and advocacy as an ethical-pedagogical practice of addressing vulnerability.

This integration gives rise to the AAT (Agency–Advocacy–Talent) model, formalized in the relationship: Talent = f (Constructed Agency X Intentional Advocacy). In this model, agency and advocacy co-construct each other in a recursive cycle that generates empowerment and potential development.

Methodologically, the AAT approach is not a standardized operational method, but rather a design approach for the construction of mediated educational environments, in which tools such as expressive workshops, authentic tasks, storytelling, narrative portfolios, personal projects, and creative digital media find a preferential place, as privileged tools for the emergence of talent as a production of meaning, rather than a performance.

From this perspective, the hospital school presents itself as a micro-ecosystem for talent development and an extreme context for testing educational democracy: not only by ensuring access to education for all, but by defending the right of every student, even the vulnerable, to build a personal vision and self-project for the future, according to the principles of educational and social justice. In this sense, talent becomes an indicator of educational justice, and vulnerability becomes not a limitation to be compensated for, but an ontological condition to be inhabited and embraced, as a generative space of possibility.

Hospital school services are designed to guarantee educational continuity for students experiencing illness and prolonged hospitalization.

Hospital teachers work within a care-centered environment, significantly different from traditional classroom settings, in which the student’s health status is the priority (Benigno et al., 2017). Within this context, however, education is not a secondary activity but a constitutive dimension of the therapeutic pathway (Rodríguez et al., 2023).

Among the critical competencies required of professionals working in pediatric hospital settings is the ability to communicate effectively with children who present Complex Communication Needs (CCN), whether due to temporary or permanent disabilities (Costello, 2000).

The absence of effective communication strategies may represent an additional source of stress, frustration and isolation for hospitalized students, especially in contexts where speech is compromised (Pina et al., 2020). Augmentative and Alternative Communication (AAC) has been described as an effective strategy to enhance interaction, safety, and participation, also in intensive care and pediatric settings (Costello, 2000). At the same time, research on complex AAC interventions underscores the need for structured, systemic approaches that include training and coordinated support of all the communication partners involved (Costello, 2000; Rodríguez, 2023). The successful implementation of AAC in hospital school therefore requires a shared commitment and aligned practices between educational and healthcare professionals.

As research highlights the need for specific AAC training among health care professionals in clinical contexts, comparable structured preparation is equally necessary for hospital teachers, who operate within the same care-centered environment and support children with CCN (Woodring & Harmon, 2023). Building on these considerations, this paper argues that accessible communication in hospital schooling should be conceptualized as a shared domain of educational and health services. AAC is examined not merely as a compensatory tool, but as an infrastructural condition enabling agency, participation, and continuity for students with CCN, including those with neurological impairments, developmental disorders, medically induced communication limitations or non-native speakers.

The theoretical discussion is informed by preliminary findings from an exploratory survey conducted with Italian hospital teachers (n = 24). The majority of respondents report working regularly with students presenting CCN. While most of the participants declare familiarity with AAC strategies, only a minority indicate having received structured or formal training in AAC implementation. These data, while based on a non-representative and exploratory sample of Italian hospital teachers, suggest a structural asymmetry: communicative complexity is recurrent in hospital school, yet, unlike special education teachers, hospital teachers are not formally required to receive specific preparation in working with students with CCN.

From this perspective, accessible communication emerges as a systemic responsibility rather than an individual initiative. If communicative mediation depends primarily on personal experience or informal knowledge, students’ effective access to both learning and care may vary across contexts, raising concerns of educational and health justice. The paper calls for the integration of communicative accessibility into teacher training models and interprofessional collaboration in hospital schooling, framing it as a foundational condition for inclusive and equitable continuity in clinical-educational environments.

Severe illness and chronic pain conditions do not merely cause school attendance interruptions but impact the temporal, relational, and agentive structure of the subject's experience. In this sense, hospital and home schooling can be further valorized not only as compensatory measures for curricular continuity but as practices capable of sustaining experiential continuity in situations of vulnerability.

This contribution proposes expanding the notion of educational continuity through an ontological, phenomenological, and hermeneutic perspective on pain, understood as a temporal and transformative process of experience. Pain, especially in chronic or protracted forms, does not present itself as an isolated episodic event but as a qualitative reorganization of the experiential horizon. It reconfigures the field of perceived possibilities - what, in ecological terms starting from Gibson and in recent enactive reinterpretations (Coninx & Stilwell, 2021), has been described as the field of affordances, i.e., perceived possibilities for action - restricting access to practices, relationships, and future projects. Illness alters time perception, compromises projectuality, and modifies the sense of belonging to the school and social context.

In this framework, school interruption is not merely an organizational issue but can amplify a discontinuity already underway on the experiential level. The absence of shared educational practices risks consolidating the contraction of the subject's horizon of possibilities. Conversely, the pedagogical relationship in hospital or home settings can contribute to reopening the agentive field: through relational continuity, the ritual of learning, and linguistic and hermeneutic mediation, understood also as a dialogical space of mutual recognition (Gadamer, 2018), it supports the connection between past, present, and future, countering relational isolation and fostering the narrative coherence of the student's identity. The analysis integrates phenomenological and narrative studies on pain - including research on the ontological modelling of pain narratives drawn from a dataset of over 800 accounts (Cipriani 2025) - with a neurophenomenological perspective, recognizing that transformations in painful experience involve bodily, affective, and cognitive dimensions, including capacities for anticipation and planning, dimensions directly implicated in the student's ability to engage with educational processes. In this perspective, educational continuity concerns not only access to content but the recognition of the student as a temporal and projective subject whose experience has been reorganized by illness.

The objective is not to replace existing pedagogical models but to offer a theoretical framework capable of dialoguing with them and making explicit the temporal and relational dimensions already operative in educational practices. From this viewpoint, educational justice does not exhaust itself in formal equality of opportunities but implies support for reconstructing the horizon of possibilities of the ill student.

Hospital and home schooling thus emerges not only as a didactic intervention but as a pedagogical care practice that contributes to recomposing the existential continuity interrupted by illness.

Hospital schooling and home instruction operate at the intersection of education and healthcare systems, where educational continuity represents a fundamental condition for ensuring the right to education for students undergoing medical treatment. In these contexts, teaching must contend with variable clinical schedules, frequent interruptions, and the need to maintain constant coordination with students’ schools of origin. Previous research has shown that working in such situations requires specific professional competencies and effective collaboration among professionals belonging to different institutional systems (Aquario, 2017; Benigno et al., 2017; Ferrari et al., 2022). However, empirical analyses of the professional and organizational conditions that shape the quality of educational responses in care contexts remain limited. Within this framework, teacher self-efficacy assumes particular relevance, as it influences the ability to manage unstable and complex educational situations (Bandura, 1997; Sharma et al., 2012) and can be interpreted as an indicator of the systemic coherence of educational action. This contribution presents an exploratory mixed-methods study with convergent data integration conducted with 47 teachers working in hospital schooling. The questionnaire investigated professional competencies, teacher self-efficacy through the Teacher Efficacy for Inclusive Practices (TEIP) scale, and perceived professional development needs. In parallel, interviews were conducted with school principals responsible for coordinating hospital and home instruction services in order to explore the organizational conditions within which teaching activities take place. Quantitative analyses were conducted using non-parametric tests and bootstrapping procedures, complemented by linear regression models aimed at examining the association between declared competencies and levels of self-efficacy. Thematic qualitative analysis made it possible to relate perceptual data to the dynamics of interinstitutional coordination. The results show medium-to-high levels of perceived self-efficacy (median TEIP = 4.11; median ACP = 4.39 on a six-point scale). Declared professional competencies are significantly associated with self-efficacy, whereas age and professional experience do not emerge as determining factors. These findings suggest that perceptions of efficacy are not automatically linked to years of service but depend more strongly on the specificity of professional competencies and on the quality of the organizational context in which teachers operate. The interviews confirm the central role of coordination with students’ schools of origin and healthcare professionals, as well as the need to adapt educational planning to students’ health conditions, in line with findings from European and Italian studies (Fabre & Labrell, 2024; Faraoni & Melchiori, 2024).Overall, the findings indicate that self-efficacy in care contexts cannot be interpreted as an isolated individual trait but rather as the outcome of an interplay between professional competencies, organizational arrangements, and the quality of interprofessional relationships. Strengthening specialized professional training and establishing stable coordination models therefore does not represent a secondary intervention but a necessary condition for ensuring educational continuity and equity in learning opportunities for students experiencing illness. The study allows teacher self-efficacy to be interpreted as an expression of institutional responsibility in guaranteeing educational continuity, offering empirical evidence that may contribute to rethinking training, coordination, and organizational structures in hospital and home instruction services.