Healthcare Beyond Earth: A Literature Analysis on “Aerospace Nursing”
DOI:
https://doi.org/10.64397/nepj.v01i01.2025.a10Keywords:
aerospace nursing, flight nurse, aerovac nursing, literature analysisAbstract
“Aerospace Nursing” is an emerging interdisciplinary field focused on addressing healthcare challenges in air and space travel, extreme remote environments, and analog missions. This analysis of 45 studies from 1975 to 2024 covers four research objectives: (1) identifying clinical and operational challenges, (2) evaluating required skills and training, (3) assessing nurses’ roles in crew well-being and safety, and (4) informing educational frameworks. A conceptual framework based on the nursing metaparadigm (“Person,” “Environment,” “Health,” and “Nursing”) with moderators (“Education,” “Training,” and “Research”) guide the analysis. Findings demonstrate physiological, psychological, and ethical issues, establish the need for trauma care and telehealth competencies, and recognize nurses’ critical contribution to mission safety. Gaps related to standardized curricula and the feasibility of adapting Earth-based nursing to space settings are identified. The analysis provides implications for practice, education, and policy, supporting the development of “Aerospace Nursing” programs.
Downloads
References
1. Barger, J. (1979). Origin of flight nursing in the United States Army Air Forces. Aviation, Space, and Environmental Medicine, 50(11), 1176-1178. https://pubmed.ncbi.nlm.nih.gov/526222/
2. Barger, J. (1980). U.S. Army Air Forces flight nurses: Training and pioneer flight. Aviation, Space, and Environmental Medicine, 51(4), 414-416. https://pubmed.ncbi.nlm.nih.gov/6989355/
3. Barger, J. (1985). Rivalry for the sky: A prelude to the development of the flight nurse program in the US Army Air Forces. Aviation, Space, and Environmental Medicine, 56(1), 73-78. https://pubmed.ncbi.nlm.nih.gov/3883982/
4. Barron, N. J. (1975). Development of aerospace nursing. Aviation, Space, and Environmental Medicine, 46(4 Sec 1), 445-446. https://pubmed.ncbi.nlm.nih.gov/1147879/
5. Borges, L. L., Haberland, D. F., Guimarães, C. C. V., Felipe, L. A. D. F., & Aguiar, B. G. C. (2022). Training of nursing in chemical, biological, radiological and nuclear defense for aeromedical evacuation in the pandemic. Revista Gaúcha de Enfermagem, 43. https://doi.org/10.1590/1983-1447.2022.20200458.en
6. Burke, J. B. (1979). The nursing explosion-technology, knowledge, and practice: Its implications for leadership in aerospace nursing. Aviation, Space, and Environmental Medicine, 50(4), 405-408. https://pubmed.ncbi.nlm.nih.gov/464967/
7. Burke, J. B. (1980). Field interactions in aerovac nursing. Aviation, Space, and Environmental Medicine, 51(6), 618-621. https://pubmed.ncbi.nlm.nih.gov/7417126/
8. Carroll, W. M., & Garcia-Dia, M. J. (2025). Introducing digital twins into nursing practice. Nursing Management, 56(7), 13-16. https://doi.org/10.1097/nmg.0000000000000283
9. Charles, J. B. (2005). Bioastronautics roadmap-A risk reduction strategy for human space exploration. National Aeronautics and Space Administration, Washington DC. https://humanresearchroadmap.nasa.gov/Documents/BioastroRoadmap.pdf
10. Chonin, A. (1998). Telehealth: Important concepts for future nursing practice in space environments. Life Support & Biosphere Science, 5(4), 433-435. https://pubmed.ncbi.nlm.nih.gov/11871451/
11. Cook, R. L. (1981). Nursing peer review: A survey of flight nurse section members. Aviation, Space, and Environmental Medicine, 52(1), 50-52. https://pubmed.ncbi.nlm.nih.gov/7213289/
12. Crucian, B., Valentine, R., Calaway, K., Miller, R., Rubins, K., Hopkins, M., Salas, Z., Krieger, S., Makedonas, G., Nelman-Gonzalez, M., & McMonigal, K. (2021). Spaceflight validation of technology for point-of-care monitoring of peripheral blood WBC and differential in astronauts during space missions. Life Sciences in Space Research, 31, 29-33. https://doi.org/10.1016/j.lssr.2021.07.003
13. Czerwinski, B. S., & Booher, C. R. (1998). Space health requirements: The challenges. Life Support & Biosphere Science, 5(4), 427-431. https://pubmed.ncbi.nlm.nih.gov/11871450/
14. Czerwinski, B. S., Plush, L. H., & Bailes, B. K. (2000). Nurses’ contributions to the US space program. Association of periOperative Registered Nurses (AORN) Journal, 71(5), 1051-1057. https://doi.org/10.1016/S0001-2092(06)61554-8
15. Damato, E. G., Fillioe, S. J., Margevicius, S. P., Mayes, R. S., Somogyi, J. E., Vannix, I. S., Abdollahifar, A., Turner, A. M., Ilcus, L. S., & Decker, M. J. (2022). Increased serum levels of proinflammatory cytokines are accompanied by fatigue in military T-6A Texan II instructor pilots. Frontiers in Physiology, 13, 876750. https://doi.org/10.3389/fphys.2022.876750
16. Davis, C. (2012). ‘Care in the air’: The role of in-flight staff. Emergency Nurse (through 2013), 19(10), 12. https://www.proquest.com/openview/f586cb7b3ff715410310231ba69cc0e7/1?pq-origsite=gscholar&cbl=32664
17. De Jong, M. J., Dukes, S. F., Dufour, K. M., & Mortimer, D. L. (2017). Clinical experience and learning style of flight nurse and aeromedical evacuation technician students. Aerospace Medicine and Human Performance, 88(1), 23-29. https://doi.org/10.3357/AMHP.4697.2017
18. de Morais, Ê. M., D'Agostini, F. C., & Albertina de Oliveira, N. (2021). Role of aerospace care nursing in Brazil: Integrative review. Brazilian Journal of Health & Biomedical Sciences, 20(1). https://www.e-publicacoes.uerj.br/bjhbs/article/view/59747/38051
19. Dubé, S., Santaguida, M., Anctil, D., Giaccari, L., & Lapierre, J. (2023). The case for space sexology. The Journal of Sex Research, 60(2), 165-176. https://doi.org/10.1080/00224499.2021.2012639
20. Eastes, L. E. (1989). Evaluating the clinical practice of flight nurses: Complexities and innovations. Journal of Nursing Care Quality, 3(3), 75-83. https://pubmed.ncbi.nlm.nih.gov/2768429/
21. Eaves, R. H., & Flagg, A. J. (2001). The U.S. Air Force pilot simulated medical unit: A teaching strategy with multiple applications. Journal of Nursing Education, 40(3), 110-115. https://doi.org/10.3928/0148-4834-20010301-05
22. Erier, C. J., Fiege, A. B., & Thompson, C. B. (2000). Flight nurse research activities. Air Medical Journal, 19(1), 13-18. https://doi.org/10.1016/S1067-991X(00)90086-5
23. Febus, D. (n.d.). Risk hierarchy: Human research roadmap a risk reduction strategy for human space exploration. Retrieved August 20, 2025, from https://humanresearchroadmap.nasa.gov/explore/
24. Fouts, B. L., Serres, J. L., Dukes, S. F., Maupin, G. M., Wade, M. E., & Pohlman, D. M. (2015). Investigation of self-reported musculoskeletal injuries on post-deployment health assessment forms for aeromedical evacuation personnel. Military Medicine, 180(12), 1256-1261. https://doi.org/10.7205/MILMED-D-14-00606
25. Gaudinski, M. A. (1979). Coping with expanding nursing practice, knowledge, and technology. Aviation, Space, and Environmental Medicine, 50(10), 1073-1075. https://pubmed.ncbi.nlm.nih.gov/518453/
26. Gilbert, H. A. (2020). Florence Nightingale's Environmental Theory and its influence on contemporary infection control. Collegian, 27(6), 626-633. https://doi.org/10.1016/j.colegn.2020.09.006
27. Gu, D., Cao, Y., Zhou, X., Zan, Y., Zhang, X., Xie, J., & Yu, M. (2023). Digital twins in the field of nursing: A literature review. CIN: Computers, Informatics, Nursing, 10, 1097. https://doi.org/10.1097/CIN.0000000000001338
28. Harper, P. (2005). Personal experience of aeromedical evacuation of patients in the Balkans. British Journal of Nursing, 14(4), 202-204. https://doi.org/10.12968/bjon.2005.14.4.17603
29. Hernandez, J. P. T. (2019). Network diffusion and technology acceptance of a nurse chatbot for chronic disease self-management support: A theoretical perspective. The Journal of Medical Investigation, 66(1.2), 24-30. https://doi.org/10.2152/jmi.66.24
30. Hernandez, J. P. T. (2022). COVID-19 infodemic in the Twitterverse: Characterization of misinformation spread and Twitter bot activity by critical mass, energy decay, entanglements, and node synchronization [Doctoral dissertation, University of the Philippines Open University]. University of the Philippines Open University Repository. https://repository.upou.edu.ph/handle/20.500.13073/524; https://doi.org/10.5281/zenodo.7030284
31. Hernandez, J. P. T. (2024). Compassionate care with autonomous AI humanoid robots in future healthcare delivery: A multisensory simulation of next-generation models. Biomimetics, 9(11), 687. https://doi.org/10.3390/biomimetics9110687
32. Hernandez, J. P. T. (2025, April 24). Aerospace nursing & space informatics: First Philippine forum. Theme: “Expanding nurses’ caring presence and knowing beyond the visible horizon” [PowerPoint presentation]. Rizal Technological University (RTU), Manila, Philippines.
33. Hernandez, J. P. T., Baliram, R., Carollo, S., & Baidoo-Kanneh, J. (2025). Nursing students in an urban setting during the COVID-19 pandemic: Investigating stress, stress response, and coping patterns by descriptive analysis, structural equation modeling, and data sonification. The Journal of Medical Investigation, 72(1.2), 102-116. https://doi.org/10.2152/jmi.72.102
34. Hoolahan, J. (2004). A pivotal role in international rescue. Professional Nurse, 20(4), 22-23. https://pubmed.ncbi.nlm.nih.gov/15624615/
35. Hutchison, B. G., All, A. C., Loving, G. L., & Nishikawa, H. A. (2001). Values identified in different groups of Air Force nurses. Military Medicine, 166(2), 139-145. https://doi.org/10.1093/milmed/166.2.139
36. Jones, D. R. (1980). Aeromedical transportation of psychiatric patients: Historical review and present management. Aviation, Space, and Environmental Medicine, 51(7), 709-716. https://pubmed.ncbi.nlm.nih.gov/6998454/
37. Kanas, N., Salnitskiy, V., Gushin, V., Weiss, D. S., Grund, E. M., Flynn, C., Kozerenko, O., Sled, A., & Marmar, C. R. (2001). Asthenia—does it exist in space? Psychosomatic Medicine, 63(6), 874-880. https://journals.lww.com/psychosomaticmedicine/abstract/2001/11000/asthenia_does_it_exist_in_space_.4.aspx
38. Kim, D. W. (2024). Astronaut selection and potential risk management: Psychological trauma and resilience for mars space mission. Trames, 28(3), 211-236. https://kirj.ee/wp-content/plugins/kirj/pub/Trames-3-2024-211-236_20240825124645.pdf
39. Kuruppu Appuhamilage, G. D. K., Hussain, M., Zaman, M., & Ali Khan, W. (2025). A health digital twin framework for discrete event simulation based optimised critical care workflows. npj Digital Medicine, 8(1), 376. https://doi.org/10.1038/s41746-025-01738-4
40. Lee, C. L., Hsiao, Y. C., & Chen, C. Y. (2012). Roles and functions of military flight nursing: Aeromedical evacuation. Hu Li Za Zhi, 59(3), 23. https://pubmed.ncbi.nlm.nih.gov/22661029/
41. Locsin, R. C. (2017). The co-existence of technology and caring in the theory of technological competency as caring in nursing. The Journal of Medical Investigation, 64(1.2), 160-164. https://doi.org/10.2152/jmi.64.160
42. Luong, K. (2024, September 10). Best software development languages for the healthcare sector [Blog post]. Ominext. Retrieved August 23, 2025, from https://www.ominext.com/en/blog/best-software-development-languages-healthcare-sector#:~:text=Python,Python%2Dbased%20healthcare%20applications%20include:
43. Majima, H. J., Indo, H. P., Tomita, K., Iwashita, Y., Suzuki, H., Masuda, D., Shimazu, T., Tanigaki, F., Umemura, S., Yano, S., & Fukui, K. (2009). Bio-assessment of risk in long-term manned space exploration—Cell death factors in space radiation and/or microgravity: A review. Biological Sciences in Space, 23(2), 43–53. https://doi.org/10.2187/bss.23.43
44. Marsh, M. (2006). Ethical and medical dilemmas of space tourism. Advances in Space Research, 37(9), 1823-1827.
45. https://doi.org/10.1016/.asr.2006.03.001
46. McEwan, M., & Wills, E. M. (2021). Theoretical basis for nursing (6th ed.). Lippincott Williams & Wilkins.
47. McGinnis, P. (1991). The future of occupational health nursing in space. American Association of Occupational Health Nurses (AAOHN) Journal, 39(5), 225-230. https://journals.sagepub.com/doi/pdf/10.1177/216507999103900503
48. McNeill, M. M., Pierce, P., Dukes, S., & Bridges, E. J. (2014). En route care patient safety: Thoughts from the field. Military Medicine, 179(8), 11-18. https://doi.org/10.7205/MILMED-D-13-00522
49. Milstead, L. (2025, May). Human Research Program integrated research plan (Revision T) (HRP-47065). National Aeronautics and Space Administration, Lyndon B. Johnson Space Center. https://humanresearchroadmap.nasa.gov/Documents/IRP_Rev-Current.pdf
50. NASA. (2023). The EVA and human surface mobility program (EHP) mission. https://www.nasa.gov/wp-content/uploads/2023/06/ehp-101-infographic.pdf?emrc=83ced7
51. Netzer, N. C., Jaekel, H., Popp, R., Gostner, J. M., Decker, M., Eisendle, F., Turner, R., Netzer, P., Patzelt, C., Steurer, C., & Cavalli, M. (2024). Oxidative stress reaction to hypobaric–hyperoxic civilian flight conditions. Biomolecules, 14(4), 481. https://doi.org/10.3390/biom14040481
52. Oxer, H. F. (1977). Carriage by air of the seriously ill. Medical Journal of Australia, 1(15), 537-540. https://doi.org/10.5694/j.1326-5377.1977.tb130873.x
53. Pandian, V., Coker, D. K., & Shelhamer, M. (2022). Nursing care in space—The need for nurses in the new and evolving field of healthcare in space. Journal of Clinical Nursing, 31(1-2). https://doi.org/10.1111/jocn.16092
54. Passos, I. P. B. D., Toledo, V. P., & Duran, E. C. M. (2011). Air transport of patients: Analysis of scientific knowledge. Revista Brasileira de Enfermagem, 64, 1127-1131. https://doi.org/10.1590/S0034-71672011000600021
55. Pavletić, B., Runzheimer, K., Siems, K., Koch, S., Cortesão, M., Ramos-Nascimento, A., & Moeller, R. (2022). Spaceflight virology: What do we know about viral threats in the spaceflight environment?. Astrobiology, 22(2), 210-224. https://doi.org/10.1089/ast.2021.0009
56. Perrin, M. M. (1985). Space nursing: A professional challenge. Nursing Clinics of North America, 20(3), 497-503. https://doi.org/10.1016/S0029-6465(22)01894-1
57. Polk-Walker, G. C. (1989). Aerospace nursing: The new frontier. Journal of Professional Nursing, 5(4), 224-230. https://doi.org/10.1016/S8755-7223(89)80055-9
58. Pugh, D. (2000). Flight nursing down under: A perspective. Accident and Emergency Nursing, 8(3), 141-143. https://doi.org/10.1054/aaen.2000.0151
59. Raduenz, S. B. D. P., Santos, J. L. G. D., Lazzari, D. D., Nascimento, E. R. P. D., Nascimento, K. C. D., & Moreira, A. R. (2020). Nurses’ responsibilities in the aerospace environment. Revista Brasileira de Enfermagem, 73, e20180777. https://doi.org/10.1590/0034-7167-2018-0777
60. Ravella, P. C. (1995). A survey of U.S. Air Force flight nurses’ adaptation to service in Vietnam. Aviation, Space, and Environmental Medicine, 66(1), 80-83. https://pubmed.ncbi.nlm.nih.gov/7695558/
61. Rivera, M. V., Vargas, M., Cornejo, J., Plascencia, P. V., Guillen, K., Maquera, E., Cornejo, J., Russomano, T., & Cinelli, I. (2024). Space nursing for the future management of astronaut health in other planets: A literature review. The Open Nursing Journal, 18(1), 1-16. http://dx.doi.org/10.2174/0118744346289848240328074640
62. Rudge, F. W. (1995). A review of articles published in aviation, space, and environmental medicine, 1975-94. Aviation, Space, and Environmental Medicine, 66(10), 1005-1009. https://pubmed.ncbi.nlm.nih.gov/8526824/
63. Schweitzer, G., Nascimento, E. R. P. D., Moreira, A. R., & Bertoncello, K. C. G. (2011). Protocol of nursing care to traumatized patients in the aerospace environment: Care before flight. Revista Brasileira de Enfermagem, 64, 1056-1066. https://doi.org/10.1590/S0034-71672011000600011
64. Shorb, G. A. (1985). An update: The flight nurse section—its past, present, and future. Aviation, Space, and Environmental Medicine, 56(5), 466-468. https://pubmed.ncbi.nlm.nih.gov/3890827/
65. Simões, M. F., & Antunes, A. (2021). Microbial pathogenicity in space. Pathogens, 10(4), 450. https://doi.org/10.3390/pathogens10040450
66. Singh, R. G. (1990). Relationship between occupational stress and social support in flight nurses. Aviation, Space, and Environmental Medicine, 61(4), 349-352. https://pubmed.ncbi.nlm.nih.gov/2339971/
67. Skinner, R. E. (1983). The U.S. flight nurse: A supplementary bibliography. Aviation, Space, and Environmental Medicine, 54(8), 735-737. https://pubmed.ncbi.nlm.nih.gov/6354171/
68. Sklaveniti, T., & Koulountzos, V. (2023). From biology to bioastronautics: Applications in elementary education inspired by STE(A)M epistemology. In ICERI2023 Proceedings (pp. 3977–3984). IATED. https://www.researchgate.net/publication/376077392_From_Biology_to_Bioastronautics_Applications_in_Elementary_Education_Inspired_by_STEAM_Epistemology
69. Smowton, A., Uthayasooriyan, A., Kamran, E., Terraciano, S., Bhavsar, P., & Russomano, T. (2025). Determining the best technique: Methods, challenges, and innovations of performing microgravity CPR. Acta Astronautica. Advance online publication.
70. https://doi.org/10.1016/.actaastro.2025.08.022
71. Space nursing - The final frontier. (2011, January 19). Nursing Standard, 25(20), 11. https://doi.org/10.7748/ns.25.20.11.s18
72. Tanioka, T. (2017). The development of the transactive relationship theory of nursing (TRETON): A nursing engagement model for persons and humanoid nursing robots. International Journal of Nursing & Clinical Practices, 4(1), 223. https://doi.org/10.15344/2394-4978/2017/223
73. Thomas, F., Clemmer, T. P., & Orme, J. F. (1985). A survey of advanced trauma life support procedures being performed by physicians and nurses used on hospital aeromedical evacuation services. Aviation, Space, and Environmental Medicine, 56(12), 1213-1215. https://pubmed.ncbi.nlm.nih.gov/4084178/
74. Tucker, R. (1990). Childbearing in space: A theoretical perspective. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 19(4), 344-349. https://doi.org/10.1111/j.1552-6909.1990.tb01656.x
75. Vallée, A. (2023). Digital twin for healthcare systems. Frontiers in Digital Health, 5, 1253050. https://doi.org/10.3389/fdgth.2023.1253050
76. Wazir, H. U., Narang, P., Silvani, G., Mehner, C., Poole, K., Burke, C., & Chou, J. (2023). Bacterial virulence and prevention for human spaceflight. Life, 13(3), 656. https://doi.org/10.3390/life13030656
77. Zhang, K., Zhou, H. Y., Baptista-Hon, D. T., Gao, Y., Liu, X., Oermann, E., Xu, S., Jin, S., Zhang, J., Sun, Z., & Yin, Y. (2024). Concepts and applications of digital twins in healthcare and medicine. Patterns, 5(8). https://doi.org/10.1016/j.patter.2024.101028
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. This license permits anyone to copy and redistribute this material in any form or format, modify, and make derivative works of this material for any purpose, including commercial purposes, as long as they credit the author for the original work.
