Teaching in any setting is a challenging profession, but have you ever thought about what it is like to teach in a hospital school? There are 10 hospital schools in New South Wales and many more around the country. Although exact figures are somewhat nebulous, an analysis of Australian Bureau of Statistics data suggests that injury and illness resulting in school restriction (defined as, ‘inability to attend school, attendance at a special school, attendance in a special class in an ordinary school, needing at least one day off a week on average, or other difficulty at school’), affects almost 60,000 Australian primary and secondary students each year (ARACY, 2015). That’s a surprisingly large number of students whose educational opportunities are potentially limited.

The combination of a major injury or illness and school absences can have a number of negative effects on students, including increased anxiety, academic under-achievement, behavioural problems and difficulties in forming and maintaining relationships (ARACY, 2015) – all of which highlight the crucial role that hospital schools play during such a difficult time in a child’s life.

Hospital schools were established in NSW as early as 1923 (http://www.royalnshos-s.schools.nsw.edu.au/, 2016), and among the first four to open was the Royal North Shore Hospital School. Like a more traditional school, the Royal North Shore Hospital School (RNSHS) has a principal, as well as two fulltime teachers and a teacher’s aide, and operates under the umbrella of the NSW Department of Education. The School’s central purpose as stated on their website is, ‘to provide an engaging, stimulating and supportive environment, assisting students to maintain educational continuity and to experience a smooth transition back to their home school’ (ibid), but on speaking with principal Vanessa Murphy, it is quickly evident that it offers so much more than that. “We pride ourselves very much on establishing straight away when we meet the child and we meet their parents and carers, what their needs are and how we can meet their needs at that point in time,” Murphy explains.

Personalised learning
This ethos permeates the School’s approach to education, where the wellbeing of the student is paramount, and the concept of personalised learning, a prominent component underpinning the Australian Curriculum, is enacted to the highest degree. “We focus very much on personalised learning, where are they at, and what are they capable of doing,” Murphy says, “and we help them get there.” To this end, each student has an individualised learning plan based on their current needs. For senior secondary students, this might be support to get assignments or assessments done, while other students may be engaged in a range of activities linked with the curriculum. “Some people think that perhaps we’re not as educational as some people might believe – but I believe that we very much work hard on providing those curriculum based activities,” asserts Murphy.

Delivering meaningful educational experiences in a hospital setting has its own unique set of challenges. Around 850 students attend the RNSHS each year, with an average of around 10 to 15 students in the program on a given day. With many of these children hospitalised for perhaps five or 10 days at a time, the population is transient and teachers often don’t know how many students they will be seeing until the day. Where possible, students go to a classroom on the Children’s Ward for their learning, however for many reasons, a particular child may not be able to leave their room, and in that case, the teacher comes to them. Careful planning also needs to go into the learning experiences to ensure that the child will be able to cope with them, and of course, if it turns out the child is not in a state to take part, their wellbeing comes first.

Given that many students would say that they don’t like school, I ask Murphy how the students feel about participating in the hospital school. “It’s pretty funny,” she replies. “Most of the kids are surprised that there’s a school and probably the biggest thing is that there is an anxiety there – ‘I’m in hospital and I’m in for this reason’ …it can be a difficult experience and it can raise anxiety levels, and then when you have the opportunity or need to go to another place in the hospital [those levels] can elevate. So what we find is there may be some anxiety simply because they don’t know what it looks like and what the experience is like. However once they are in there and have had a wonderful session with our staff and are totally engaged, we actually get students saying, ‘When can we come back?’ They love it!” Murphy believes that this is because attending the hospital school takes kids out of the space of their room and why they’re in hospital, providing an often welcome distraction.

To alleviate some of the anxiety children might feel, the Royal North Shore Hospital School recently teamed up with four other hospital schools in NSW – Liverpool, Bankstown, Illawarra and John Hunter – to produce a short video to introduce the idea of participating in educational experiences in hospitals to students. The video, which features a purple puppet called Abigail, simulates the experience of a six-year-old faced with the prospect of hospital school, and her subsequent discovery, recounted in the form of a catchy song, that it’s not so different from regular school. Available via YouTube and through each hospital’s website, the video is accessible from within the hospital on devices such as iPads, and can also be viewed by students and their classes at their home school. Two other videos were also created as part of the project – one chronicling the first day of teenager Alistair as he begins at hospital school, and the other providing introductory information about what hospital schools are and how they work. It is hoped that they will help raise the profile of the important function that hospital schools play in our education system.

Home school cooperation
In addition to supporting their students, staff of the RNSHS play a key role in helping parents and carers through what is usually a very stressful time. “For a lot of the children that come in, I have contact with the principal from their home school and if they’re requiring work then I make sure that there is that communication set up, that they’re aware that the child is in hospital,” Murphy says. “Really we are the link between the family and their home school and a big part of my role is to take the load off the parents and family in having to do all that contact work. And you know, they’re struggling as well. They’re often anxious or tired or a whole range of emotions so whatever we can do to support the families as well, that’s very important for me… when they have that assistance it takes a lot off their mind because as I think obviously after their first thought of how long will my child be unwell, the second thought is what’s going to happen with school. It’s really important…”

Flexible school days
So what does it take to teach in a hospital school? Flexibility is one of the most important attributes. In addition to not knowing who you might be teaching from one day to the next, hospital school educators also have to be willing to adapt to student needs at a moment’s notice. This might mean conducting learning in a variety of different locations, from the student’s room to different spaces close to the ward to the hospital’s classroom, or changing planned activities in response to a student’s condition on a particular day.

Murphy also stresses the importance of teachers participating in regular learning themselves to ensure their knowledge and skills are up to date. “We work hard on maintaining a high professional standard with our staff so there’s a lot of time goes into professional development,” she explains. Teachers are regularly engaged in learning covering key areas such as mental health and technology. Currently they are also investigating how students can access cloud technology to enhance their learning.

At the heart of the personalised learning approach that is a cornerstone of the RNSHS is the ability to build good relationships with students, parents and other health professionals such as occupational therapists with whom teachers have interactions. “Our staff are absolutely wonderful in just being compassionate and caring and understanding and totally connecting with each student who comes in,” Murphy says. “What makes it even more special is the level of understanding that we have, and I think it’s in line with our school banner statement – connect, learn, empower…without connection there’s no learning.” Good communication is therefore also critical, and the hospital school staff strive to work cooperatively with other members of each child’s health team to ensure that the wellbeing of the child remains the number one priority.

The degree of commitment that staff have to achieving the best outcomes possible for students in challenging circumstances shines through as Murphy describes some of the School’s successes. Last year, for example, they had a professional artist conduct an art workshop from which staff learned methods and techniques which they are now using with other students. Drawing on creativity is often a good way to engage a student who is not feeling 100 per cent and Murphy explains that it’s not unusual for students to have an ‘I can’t believe I did that’ response to the work that they produce. “To actually have that experience in a time that’s pretty stressful for them and the family I think is fantastic,” she adds.

Staff capitalise on this by being equally creative in their approach to teaching literacy and numeracy. “When you tap into somebody’s creative side, it’s just absolutely wonderful because often they didn’t even know it was there or they didn’t think they were good at that. So for them to have success in that area is wonderful,” Murphy says. A music therapist also comes in to work with students, whether they are musical or not, to support the learning. She has even been known to help students learn sight words by strumming along on the guitar, Murphy recounts.

School absence can have a big impact on both the academic and social outcomes of affected students. A US study found that 45 per cent of students with chronic illness report falling behind in their school work, leading them to dislike school (Lynch, Lewis & Murphy, 1992) and one can surmise that young people in Australia may have similar experiences. Institutions such as the Royal North Shore Hospital School therefore play a critical, but often unheralded role in not only supporting students’ academic learning, but also in maintaining their wellbeing and self esteem. Vanessa Murphy knows this only too well. “There’s a lot of people doing really good work [in hospital schools] and people don’t even know it’s going on,” she says.

Further reading
Australian Research Alliance for Children and Youth (ARACY). (2015). Missing School – Part 1: School connection for seriously sick kids : who are they? Canberra, ACT.
Lynch EW, Lewis RB, Murphy DS (1992). Educational services for children with chronic diseases: perspectives of educators and families. Excep Child 49:210-220.
Royalnshos-s.schools.nsw.edu.au. (2016). Royal North Shore Hospital School | School History. [online] Available at: http://www.royalnshos-s.schools.nsw.edu.au/history-of-the-hospital-school [Accessed 17 Apr. 2016].