Children and adolescents with chronic or severe illnesses occupy a particularly vulnerable position within educational systems, as their right to education is repeatedly challenged by prolonged absences, medical treatment, and psychosocial strain. Hospital school education responds to this tension by creating pedagogical spaces at the intersection of schooling, medicine, and care. Within these spaces, teachers are confronted with complex and often uncertain situations in which pedagogical action must be continuously negotiated under conditions of emotional strain, institutional fragmentation, and shifting responsibilities (Fesch & Müller, 2014; Bakels, 2020). In this sense, hospital schools can be understood as socially condensed sites in which broader societal transformations—such as changing conditions of knowledge production, blurred institutional boundaries, and increasing demands for context-sensitive professional action—become particularly visible.

In this context, educational transitions—from illness to hospital schooling to reintegration into mainstream schools—emerge as critical situations of professional knowing and acting.
Against this background, the paper addresses the following research questions:
(1) Which dimensions of professional competence enable teachers in hospital school settings to translate pedagogical and medical knowledge into responsible action during transitional phases?
(2) How is professional competence enacted in the coordination of transitions, and which forms of knowledge are activated—particularly in collaboration with families and home schools ( (Äärelä, Määttä, & Uusiautti, 2018)?

The study presented here aims to reconstruct the competence requirements that shape pedagogical action in transitional educational contexts such as hospital schooling and to analyse how different forms of professional knowledge are mobilised, negotiated, and transformed into situated action. To address this aim, the study draws on an integrated theoretical framework that combines a competence-theoretical perspective with German-language curriculum theory. The COACTIV model of professional competence serves as a heuristic structure for systematically analysing professional knowledge, beliefs, motivational orientations, and self-regulatory capacities as interrelated dimensions of pedagogical professionalism (Baumert & Kunter, 2006; 2011). This competence-oriented perspective is complemented by a curriculum-theoretical understanding of professional action as a fundamentally reflexive process in which pedagogical responsibility, judgement, and meaning are continuously negotiated in relation to concrete situations (Hopmann, 2007; Künzli et al., 2013). From this combined perspective, hospital school education emerges as a paradigmatic transitional context in which educational action unfolds under conditions of institutional overlap, uncertainty, and vulnerability, making the reflexive connection between knowing and acting a central requirement of professional competence.

A convergent mixed-methods design was employed (Creswell & Plano Clark, 2018), integrating qualitative and quantitative data from Germany, Austria, and Switzerland: The empirical basis consists of three interconnected strands: (1) a quantitative online survey of teachers working in hospital school settings, including open-ended responses; (2) semi-structured interviews with hospital school teachers; and (3) expert interviews with school administrators and other key stakeholders involved in transition processes. In addition, a document analysis of university curricula and continuing professional development programmes was conducted to contextualise professional learning opportunities. Quantitative data provide insights into generalisable patterns of perceived competence requirements and transition-related challenges, while qualitative data capture contextualised experiences, interpretative practices, and decision-making processes. Qualitative data were analysed using thematic and qualitative content analysis, supported by multiple coding and consensual validation procedures (Mayring, 2022). Quantitative and qualitative findings were first analysed independently and subsequently integrated to identify convergent and complementary patterns. The COACTIV model served as an analytical frame to relate dispositional professional knowledge and orientations to situational demands of pedagogical action, particularly in moments of transition between hospital schooling and home schools. This perspective is further informed by integrative competence approaches that conceptualise competence as a continuum between dispositions and performance (Blömeke et al., 2015).

The findings reveal a differentiated profile of professional competence requirements in hospital school education, with educational transitions emerging as key sites of knowing and acting, consistent with international research on hospital pedagogy as a distinct and under-theorised professional field (Ávalos & Fernández, 2021; Elbracht et al., 2023). While subject-related and pedagogical knowledge largely correspond to general teacher education, specific emphases become visible in relation to transition-oriented diagnostics, adaptive instructional planning, communication with home schools, and coordination within multi-professional networks. Across data sources, a persistent knowledge–action gap is evident. Although relevant professional knowledge and inclusive orientations are widely articulated, their translation into situational pedagogical decision-making during transitions remains fragile and highly contingent. Teachers act as boundary workers who translate between educational, medical, and organisational logics while negotiating expectations, responsibilities, and notions of belonging with students, families, and home schools. This finding resonates with research highlighting the situated and contingent nature of professional judgement in complex educational settings (Blömeke et al., 2015; Bakels, 2020). Professional competence in hospital school education is fundamentally transitional: it is shaped, tested, and enacted in situations of dire straits and change. By foregrounding transitions as central to professional action, the study contributes to current debates on knowing and acting in education research under changing conditions and highlights the importance of competence-oriented perspectives that acknowledge uncertainty, responsibility, and relational work.

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