FLight

Competencies:an integrated career and competency

framework for in-flight nurses

RCN CompetenciesRCN Competencies

Acknowledgements We would like to thank all those who have led the work on thiscompetency document, the past and present members of the In-flight Nurses Association (the forum of in-flight nurses in theRCN) steering group:

Gerry Bolger (Chair)

Mark Payne

Caroline Carter

Val Pitman (until Oct 2006)

Rita Mody

Chrissie Timms (until Oct 2006)

Catherine Gates (until Oct 2006)

Terry Little (until Oct 2006)

Nina Ebbs (RAF co-opted member)

Ryan McNay (from Nov 2006)

Rachel Leader (from Nov 2006)

Alan Sheward (from Nov 2006)

We are also grateful for the support, guidance and resoluteness ofRachel Rowe, Bernie Cottam and Lyn Garbarino, which cannotbe understated. Thanks must also go to all those in-flight nurses,assistance companies and stakeholders who were involved in thismammoth undertaking.

This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers areadvised that practices may vary in each country and outside the UK.

The information in this booklet has been compiled from professional sources, but its accuracy is not guaranteed. Whilst every effort has beenmade to ensure the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in which itmay be used. Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be causeddirectly or indirectly by what is contained in or left out of this website information and guidance.

Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN

2007 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmittedin any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers or alicence permitting restricted copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. This publicationmay not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it ispublished, without the prior consent of the Publishers.

R O Y A L C O L L E G E O F N U R S I N G

1

Competencies: an integrated career and competencyframework for in-flight nurses

Foreword 2

Introduction 3

1. How to use the framework 4

Benefits of the framework 4

The competency levels 4

The building blocks for professional development 4

Using the framework 4

In-flight nursing competency model 5

Producing evidence 5

What is evidence? 6

Professional accountability 6

2. Competencies 7

Core competency 1: Self-assessment 7

Core competency 2: Being patient and person-centred 10

Core competency 3: Using evidence-based practice 11

Core competency 4: Practice expertise 12

Practice expertise assessment 13

Practice expertise planning, providing and evaluating specific

interventions, treatments and therapies 14

Core competency 5: Leadership and management in in-flight nursing 15

3. References 16

Approved until January 2008

Contents

2R C N C O M P E T E N C I E S I N - F L I G H T N U R S E S

Foreword

Competencies: an integrated career and competencyframework for in-flight nurses was written by in-flightnurses, for in-flight nurses with the support of the RCN toprovide a comprehensive document that will help nursesgive a high standard of in-flight nursing throughout theUK. It is the result of four years of extensive work andconsultation. The framework is the product ofcollaboration between in-flight nurses from all over theUK and service users, and specialists in other areas suchas insurers and assistance companies. Evidence from theNursing & Midwifery Council (NMC) was also used toensure that the framework is fit for purpose, and considersareas where in-flight nurses may be active in the future.

The catalyst for this work was the recognition that acompetence framework was needed to enable in-flightnurses to describe and show their competence in acomplex, and little understood, nursing specialty. Thelimited access to formal education, the variability ofeducational provision and the lack of portability ofcomplex skills, were key issues raised by in-flight nurseswhen the competence framework was initially discussed.

The In-flight Nursing Forum steering group welcomesfurther comments and suggestions from practitioners. Wewant to ensure the framework remains current andrelevant to those involved in the care of people whiletravelling by air. Please contact: [email protected]


3

Introduction

Competence can be defined as: The state of having theknowledge, judgement, skills, energy, experience andmotivation required to respond adequately to thedemands of ones professional responsibilities (Roach,1992).

The changing context The fields of nursing are highly specialised, and subjectto dramatic change as innovations and new techniquesare adopted. The In-flight Nursing Forum believes thatprofessional advice and support are required for nursesdeveloping their roles in a dynamic and rapidlyadvancing field.

The competency framework has been developed in thiscontext, as well as taking into account other professionaland political factors such as:

Agenda for Change (DH, 1999) need for leadership in specialist nursing need for the development of UK-wide standards in

in-flight nursing

NHS Plan (DH, 2000) and its equivalent in Scotland,Wales and Northern Ireland

increased focus on work-based and lifelong learningplus supervision

increasing patient and user expectations inconsistency of provision and access to in-flight

nursing education in the UK

need for professional accreditation of skills andknowledge in practice

national service frameworks and servicemodernisation

Future Nurse (RCN, 2003) pioneering work by the RCN Accident and Emergency

Association and the Faculty of Emergency Nursing

knowledge and skills framework (DH, 2003).

Agenda for Change Agenda for Change (AfC) was implemented in the NHS,across the UK in December 2004. It was the biggestoverhaul of NHS-wide pay, terms and conditions in over50 years. It applies to all NHS organisations and thereforesets a UK framework for pay, terms and conditions ofemployment.

AfC and its knowledge and skills framework (KSF)means that all staff will have clear and consistentdevelopment objectives; can develop in such a way thatthey can apply the knowledge and skills appropriate totheir level of responsibility; and are helped to identifyand develop knowledge and skills that will support theircareer progression.

Under AfC jobs are evaluated using a bespoke NHS jobevaluation scheme. This gives each job a weighting thatthen determines where each job slots into the new paybands. Common job profiles continue to be developedand are applicable across the UK, and where a job fits aprofile it is possible to place it straight onto anappropriate new pay band. For the relatively few jobs thatdont automatically fit a profile, trained job evaluatorsdrawn from management and staff side carry out theevaluation using a Job Analysis Questionnaire (JAQ).Each pay band has a number of pay points. Staff belowthe maximum point can expect to progress to the nextpoint each year.

There are two points on each pay band called gatewayswhere staff knowledge and skills are assessed using theknowledge and skills framework. Pay progression at thegateways is linked to the demonstration of appliedknowledge and skills to support continuing professionaldevelopment. The presumption in the KSF is that staffwill pass through these gateways unless there are reasonsas to why they shouldnt.

For more comprehensive information on Agenda forChange please refer to www.rcn.org.uk/agendaforchange/This site is your guide to the ins and outs of the pay,terms and conditions for the NHS. It will help you tounderstand AfC, how it was developed, what you canexpect from your new pay, terms and conditions and howyou can make the most of the new system, particularlythe KSF. To ask questions and debate issues use the RCNsDiscussion Zone in the members-only area.

How to use theframework

The framework focuses on knowledge, skills andinterventions that are heightened or specific to nursesworking in any in-flight setting. Although the intention isfor this framework to have a stand-alone function itshould be used in conjunction with other frameworks thatfocus on core skills and competencies for all qualifiednurses. In addition the specific frameworks developed byspecialist nurses can be used to support and enhance in-flight nursing practice.

Benefits of the framework

The competency framework provides benefits for nurses,their employers, patients and the public.

Nurses benefit because it helps you to:

deliver consistently high standards of care identify your level of practice and plan your career in a

more structured way

pinpoint personal education and development needs realise your potential more effectively seize opportunities to influence the direction of

nursing.

Employers benefit because it provides:

a model to ensure consistently high standards of care clearer insight into the expertise and competence of

staff. For example, in assessment of risk management.

Patients and the public benefit because it makes it possibleto deliver:

consistently high standards of patient care increased effectiveness to service provision improved access and choice for care provision.

The competency levels

The framework has three levels of competency and has thepotential to be cross-referenced with the knowledge andskills framework in greater detail at a later date. There isalso scope to add non-qualified (health care assistants)and consultant nurse levels as and when appropriate.

4

R C N C O M P E T E N C I E S I N - F L I G H T N U R S E S

1The levels are:

Level 1: competent nurse

Level 2: experienced/proficient nurse

Level 3: senior practitioner/expert nurse.

The framework is intended to:

help individual nurses plan their professionaldevelopment in in-flight nursing

act as a model of care for nurses in all settings whocare for in-flight patients

provide guidance to employers about expectations ofcompetency at different levels of in-flight nursingpractice

act as a framework for educationalists to use whenplanning and revalidating educational provision toreduce the theory/practice gap, and show consistencyin in-flight nursing

capture the unique contribution to care that in-flightnurses make

provide a model to use in the development of new in-flight nursing roles such as those in primary care or invisual rehabilitation

provide a framework for career progression in in-flightnursing.

The building blocks forprofessional development

The clearly defined competency levels make it possible forin-flight nurses to identify their level of practice. Theframework gives you the ability to plan your career in amore structured way, and supports your continuingprofessional development by pinpointing individualdevelopment and training needs.

By developing competencies for in-flight and other nursingspecialisms, the RCN is providing the key building blocksfor improving professional practice in nursing. This willraise the quality of care, and ensure that patients andemployers benefit from consistently high standards.

Using the framework

This document is intended to complement the UK-wideRCN Core competency framework and focuses on specificnursing interventions. The framework should be used as adeveloping, empowering and aspirational tool, as well as ameans of managing performance within professionaldevelopment and appraisal schemes.

It is envisaged that this framework could be used by anynurse working in an in-flight setting. The corecompetences have been written so that whatever the caresetting, most are achievable. The specialist competenciesare designed to enable each nurse to map competenceacross the whole range.

When the competencies are added to the RCN Corecompetence framework, the model works as the diagramabove illustrates. However, it will also work as a model ofin-flight nursing practice without the genericcompetences.

Producing evidence

You are responsible for gathering evidence for eachcompetency to demonstrate that you have achieved it atthe identified/desired level. Forms of evidence that you canuse include:


5

In-flight specialistcompetence at

competent level

In-flight corecompetence at

competent level

Generic competence at competent level

A competent in-flight nurse

In-flight nursing competency model

In-flight specialist competence atexperienced/specialist level

In-flight core competence atexperienced/specialist level

Generic competence atexperienced/specialist level

An experienced/specialist in-flight nurse

In-flight specialist competence at expert level

In-flight core competence at expert level

Generic competence at expert level

An expert in-flight nurse

case histories self-appraisal via a reflective diary 360-degree feedback verification of practice and structured observation of

practice.

When you gather evidence it is important that youconsider the following:

what is the competency statement asking of you? is the existing evidence appropriate? For example,

certificates of attendance at training events areinsufficient to demonstrate knowledge or competencein practice. You will need to demonstrate theknowledge that you have gained and how you use thisin practice. Assessment of competence in practice alsorequires supervised practice by a competentpractitioner until you both agree that competence hasbeen demonstrated

what else do you need to do to develop evidence? Forexample, consider reflection and feedback on practice

do you have any further development needs, and howcould these be met?

could the evidence that you have be used to coverseveral competencies? For example, one case studymay demonstrate that you have used a variety ofknowledge and skills in caring for a patient. In thisinstance you should be able to measure the evidenceagainst several competencies.

What is evidence?

There is a variety of material that you can collect tocapture evidence of competence. This may include:

evidence of supervised practice such as signedobservation of undertaking a procedure

work-based projects practice developments/changes in practice tape recordings critical incidents reflective diaries log books evidence of qualification assessments and appraisals publications and presentations audits teaching packages poster certificates of attendance with reflection on learning evidence of group work policy and protocol development standard operating procedures evidence of membership of advisory groups research and evidence-based reviews witness statements when focused and well structured.

Professional accountability

The NMC Code of professional conduct: standards forconduct, performance and ethics (2004) states:

As a registered nurse, midwife or specialist communitypublic health nurse, you are personally accountable foryour practice. In caring for patients and clients, you must:

respect the patient or client as an individual obtain consent before you give any treatment or care protect confidential information co-operate with others in the team maintain your professional knowledge and competence be trustworthy act to identify and minimise risk to patients and

clients.

The code goes on to state that as a practitioner:

You are personally accountable for your practice. Thismeans that you are answerable for your actions andomissions, regardless of advice or directions from anotherprofessional.

It also goes on to state:

You have a duty of care to your patients and clients, whoare entitled to receive safe and competent care, and thatyou must adhere to the laws of the country in which youare practising.

6


6


7

2

Pre-transfer:

undertake a pre-flight assessment ofself - including health, competency topractise (knowledge base, expertise,physical skills), rest, appropriatevisas etc)

plan an assessment for a range ofpatients using an evidence-basedapproach to practice

evaluate data available and selectappropriate equipment and toolsrequired for planned repatriation

undertake a full pre-flightassessment of patient using anevidence-based approach to practicewith regard to patients medicalcondition, taking into accountindividual needs and proposeditinerary

Pre-transfer:

offer support/mentorship to lessexperienced nurses

challenge care practices (whereappropriate) and decide on carepriorities

plan an assessment for multiplepatients or assess complex cases.

Pre-transfer:

use evidence-based research toimplement policy and protocolsrelating to in-flight procedures

receive and provide highly complexinformation

be able to allocate to repatriationsto flight nurses according toqualification, expertise, skill andpersonal strengths

plan an assessment for largenumbers of patients and/or highlycomplex cases

develop specialised programmes ofcare

develop in-flight care services

provide clinical and logistical adviceon aeromedical transfer and care

plan and implement competencytraining and personal developmentprotocols

reconcile inter and intra-professional differences of opinion

lead on developments in nursingpractice actively.

During transfer:

assess, plan implement and evaluatethe care for a range of patients usingan evidence based approach topractice

ability to adjust care according toneed.

During transfer:

assess, plan, implement andongoing evaluate care delivered andadjust to own sphere of competency

adjust nursing care and therapeuticinterventions in own range of skillsand competencies.

During transfer:

provide support for others asnecessary and offer practical adviceand information if required

evaluate care provided by othersand appraise critically as necessary

prepare to address shortfalls ofstandards sensitively.

Competent nurse Experienced/proficient nurse Senior practitioner/expert nurse

Under the direct supervision of an

expert nurse

Under the minimum guidance and

supervision of an expert nurseWithout guidance or supervision

Core competency 1: self-assessment

Competencies

8R C N C O M P E T E N C I E S I N - F L I G H T N U R S E S

Post-transfer:

provide discharge to the appropriateauthority (including medicaldocumentation that relates tomedical history, transfer history,investigations etc, personaldocumentation and property)

evaluate own care practices againstaccepted standards and guidance

ensure appropriate documentation isprovided to both patient and/or caresetting, and assistance organisation,maintaining confidentiality at alltimes.

Post-transfer:

assess patient for appropriatedischarge arrangements, and act inthe patients best interest

evaluate own care and act as aresource to other nurses in ensuringtheir care is evaluated againstaccepted standards and guidelines

support others in appropriatedocument management andappraise others critically in recordkeeping within professional andlegal boundaries.

Post-transfer:

evaluate teams care practices

evaluate local policies arounddischarge, documentation andconfidentiality

audit documentation to ensureappropriate standards and guidanceare maintained, and appraiseindividuals on progress as required.

General:

demonstrate an awareness of otheragencies involved (such as travelunderwriter, assistance companies,agents, airlines, ground transportagencies) their role andresponsibilities

follow a recognised pathway ofprofessional development andensure acute clinical practice ismaintained

provide a flexible plan of care for avariety of patients to include pre, inand post-flight settings usingevidence-based approach

evaluate all such care using anevidence-base approach to practice

provide appropriate dischargeprocedures such as handover ofpatient, care, medical/personaldocumentation and property

demonstrate the foundation skills topractise in the in-flight setting(BLS/ILS/ALS as appropriate)

demonstrate the process ofprofessional development relating toplanning to achieve next level status

implement treatment plans

assess fitness for aeromedicaltransfer and have a comprehensiveunderstanding of the procedureshould a patient not be fit toundertake the pre-arranged transferor require additional facilities (thanthat already arranged)

demonstrate awareness of alladvisory resources

know how to access relevantinformation regarding a patient andthe appropriateness ofcommunication of that information toother parties

General:

liaise with other agencies involved

decide clinically on priorities in thecare setting

challenge care practices andprocesses and decide on carepriorities

interpret care practices andprocesses in the care setting, andevaluate them

take responsibility for leading ateam

provide support and mentorship toothers in the competency framework

liaise with other agencies in the in-flight setting to ensure the care andwellbeing of thepatient/family/carer is paramount

follow the developmental pathwayand show evidence of it (portfoliosetc)

continue to develop self and othersin all professional activities

demonstrate ability to anticipateeffects of flight including stress,long haul travel, circadian rhythmchanges on patients, travellingcompanions and self.

demonstrate ability to initiatespecific treatment prior to transfer

support junior nurses in dealingwith unfit clients/patients

provide training to enhancecompetent nurse assessment skills

develop protocols for patientassessment

demonstrate ability to analyseresearch base for the continueddevelopment of both in-flightnursing and multidisciplinarypractice

General:

co-ordinate and make judgementsand decisions relating to thefacilitation/relationship with otheragencies

manage conflicting views wheredecisions affect safety and/orclinical governance in the in-flightenvironment

take responsibility for deciding onthe priorities in patient care withoutguidance or supervision

organise independently all aspectsof nursing care for patients relatingto in-flight nursing repatriations andtransfers

provide an active lead in thedevelopment of nursing practicethat is relevant to in-flight nursing

continue to improve and enhanceevidence-based practice for in-flightnursing

undertake research activities andimprove current research with ownwork

implement policy and protocolsrelating to in-flight procedures

train and develop staff in thedevelopmental framework

continue to develop excellence inpractice and encourage the same inothers

assess priorities, plan, treat andsafely discharge patients presentingfor in-flight repatriation or transfer

evaluate data clinically to select andimplement appropriate care

make operational judgements andprovide advice in all aspect of in-flight nursing care


9

assess all patients accurately andrecognise actual and potentialproblems

demonstrate a working knowledge ofobservations that are appropriate tothe clinical needs of the patient bothpre, during and post-flight

assess, prioritise and plan careholistically for patient requiring in-flight care

assess and implement treatmentregimens

demonstrate awareness ofprocedures for dealing with the unfitpatient

demonstrate awareness of advisoryresources available

anticipate the effects to individualsof inflight environment includingtime zones, stress and long haulflights

maintain own personal developmentplan

demonstrate awareness of healthand safety legislation around in-flighttransfers and make appropriate riskassessments.

have appropriate skills to researchand evaluate effectively andaccurately to promote excellence

realise the importance of compilingresearch evidence as a part of theworking routine of an autonomousin-flight nurse

communicate all research findings tothe multidisciplinary team, realisingits value as a learning tool.

contribute to the knowledge base ofaeromedical practice by applyingand critiquing research/innovationsto practise

integrate specialist theoretical andresearch evidence base into thecontinued development of clinicalpractice

attend and review relevant clinicalmeetings to discuss researchfindings in order to streamlinefuture protocols.

act as an advisory source forsuitability to fly for patients

give advice and direct policy in therepatriation of patients

make operational judgements inrelation to assessment

ensure that tools and protocolsdesigned for patient assessment inthe in-flight setting are research-based and current

teach and develop the skills of teammembers to ensure effective,evidence-based care is providedthat reflects up-to-date guidancerelevant to in-flight nursing

contribute to the evidence base forin-flight nursing practice to supportand promote in-flight nursing

identify areas for further researchand directly contribute to that bodyof knowledge for aeromedicalpractice

develop educational tools andpackages to present researchevidence to the multidisciplinaryteam

implement relevant clinicalmeetings and update databaseswith changes and developments.

10


demonstrate knowledge of therationale behind the management ofthe physiological, social and spiritualneeds of the patient in the in-flightand transport environment

demonstrate awareness of their rolein providing a duty of care

provide patient-centred care in thelimit of experience and training

provide care for all patients andrelatives in an appropriate manner,maintaining empathy, sensitivity andreassurance

be accountable for own professionalpractice

receive and communicate sensitivecondition-related information in acaring and confidential mannerappropriate to the situation andlocation

assess appropriately a patientssuitability for flight and can act toensure safe repatriation

demonstrate appropriate clinical andnon-clinical assessment skills forpatients, ensuring safe repatriationand transfers

ensure the spiritual needs of patientsare met when possible and in theconfines of environment of care.

ensure policies and procedures arefollowed to maintain patient careand safety in the aeromedical/transport environment

use advanced nursing skills toassess and provide high qualitytherapeutic nursing care in theaeromedical environment

receive and communicate highlysensitive information

apply policies and procedures inpractice to ensure that all careprovided is patient-centred

demonstrate awareness thatpolicies and procedures are in placeto address the needs of dyingpatients/death in transit or in-flight

demonstrate accountability(unsupervised lead in certain areas)for all areas of practice

demonstrate patient-centred carerelated to extended training andprofessional experience

provide supervision of the welfare ofstaff including equal opportunitiesand related legislation

decide on nature and type ofdischarge for patients includingappropriate policy development forthe competent level nurse

conduct an assessment of treatmentaccurately, undertake a physicalexamination and interpret findingsto an enhanced level

instigate specific treatment prior toflight and advise medical facilitieson pre-flight requirements (bloods,anticoagulants etc).

develop and implement policy withregard to patient-centred careappropriate to the in-flightenvironment

demonstrate skills to receivecomplex clinical information tomake safe patient-focused decisions

demonstrate ability to presenthighly complex patient/clinicalinformation to all stakeholderswhile maintaining confidentiality asappropriate

ensure actions are appropriate tobeing the patients advocate

support colleagues in advocatinghigh quality care

use patients views and feedback toinform and adjust the provision oftreatment and care of futurepatients

ensure appropriate selection ofsuitably registered and trainednurses to patient specific needs,allowing for sensitive care andprotection of patient and nursewithin national guidance orrecommendations

ensure that nurses/practitionersprovide patient-centred care withrelation to advanced practice andhigher level of training andexperience

instigate and monitor equalopportunities training and complywith related legislation

ensure nurses are supported as loneworkers in the in-flight environment,and work appropriate hours as perthe European Working TimeDirective.


Core competency 2: being patient and person-centred


11

demonstrate an up-to-dateknowledge of the physiologicalaspects of aviation and how thisaffects the care of patients

comply with audit procedures andpolicy changes

conduct audit of own work

implement revised and new careprotocols that are evidence-basedand support care in the in-flightenvironment

provide feedback with regard topractices and procedures.

share advanced knowledge ofphysiological aspect to others toreduce risk and enhance patientcare

assist in the collation anddevelopment in the audit of in-flightcare clinical practice

conduct and assist in research inareas of in-flight clinical practicewithin appropriate legal and ethicalcodes for research.

undertake clinical audit of in-flightpractices and act on findings todevelop and improve standards ofcare

conduct research within legal andethical codes and disseminatefindings to in-flight nurses regardingcare delivery

ensure appropriate evidence-basedpolicies and procedures are in placeto ensure the highest standard oftreatment and services

provide evidence for revision ofpolicies and protocols on a regularbasis in liaison with other in-flighthealth care providers andstakeholders

benchmark care against national orinternational indicators andstandards and use findings toenhance care.


Core competency 3: using evidence-based practice

12


Core competency 4: practice expertise

demonstrate a comprehensiveunderstanding and knowledge of thegas laws, the effects of altitude andtravel and the principles of aviationmedicine in day-to-day practice

ability to anticipate the effect of anursing diagnosis, respondappropriately and adjust care toenhance wellbeing and maintainsafety in the air and in transit

demonstrate competence in themonitoring of clinical signs in-flight inrelation to aviation medicine and usea problem-solving approach toproviding care

demonstrate self-awareness of owncompetencies, and ask for help, andseek assistance appropriately

undertake a full risk assessmentprior and during each stage oftransfer or start of clinical procedure

administer treatment and medicineswithin agreed professional conductstandards and national protocols andprocedures

follow care pathways in own field ofexpertise and registration on NMCregister

demonstrate a comprehensiveknowledge of the anatomy andphysiology of all body systems

demonstrate an understanding ofnon-medicine prescribing and adhereto written protocols appropriate toin-flight care

understand the relevance and effectsof in-flight environment on ongoingpatient monitoring

work within your level of clinicalcompetency to ensure clinicalstandards are maintained

maintain own acute care nursingskills and regularly update practice inacute care

develop and audit patient protocolsin relation to in-flight care

demonstrate ability to use IT in thein-flight setting

understand and correctly use in-flightdocumentation.

demonstrate an enhancedknowledge of in-flight nursing.

ability to explain to patients, carersand other non-aviation experiencedhealth personnel using examples

assist in the development of carepathways relevant to in-flightnursing

demonstrate a detailed knowledgeof the anatomy and physiology of allbody systems

Demonstrate an enhancedknowledge of relevant drugtherapies and their use in the in-flight setting

develop and use drug protocols

demonstrate a proven enhancedknowledge of the effects of altitudeand principles of aviation medicine

develop this knowledge in others

demonstrate an enhancedknowledge of gas laws

demonstrate comprehensive in-flight monitoring skills and ability torelate them to aviation medicineprinciples

work within level of clinicalcompetency to ensure clinicalstandards are maintained

develop and act on audit in theclinical setting to enhance inflightpractices

develop and use in-flightdocumentation.

demonstrate a comprehensiveunderstanding of logistical andnursing issues of travel andaeromedical care

ability to present information tolarge groups/other health careprofessionals

anticipate the likely course of apatients disease process/treatmentand use own specialist knowledgeto effect best outcome

develop protocols and proceduresfor specialist monitoring in theaviation medicine field

develop care pathways in a clinicalframework that reflects bothinternational and national standards

audit and disseminate evaluation ofdecisions made

develop and appraise audit toolsspecifically for in-flight nursing care

use expert knowledge to anticipatethe likely effects of flight and actappropriately to limit risk to patient.

initiate and supply relevanttherapy/treatment using specialistknowledge

develop tools and protocols foraviation medicine and in-flightmonitoring

develop and conduct appraisals ofnursing staff performance andensure ongoing development

develop IT systems to support in-flight practice.



13


Assessment

assess, prioritise and plan care forpatients requiring in-flightrepatriation or transfer holisticallyand accurately. Care should beappropriate to individual and clinicalneeds recognising actual andpotential problems

implement agreed treatment plansand protocols

ability to assess fitness foraeromedical transfer and have acomprehensive understanding of theprocedure should a patient not be fitto undertake the pre-arrangedtransfer or require additionalfacilities (than that already arranged)

know how to access relevantinformation regarding a patient andthe appropriateness ofcommunication of that information toother parties

demonstrate a working knowledge ofobservations that are appropriate tothe clinical needs of the patient bothpre, during and post-flight

assess and implement treatmentregimens

assess a patients suitability for flightand act to ensure safe repatriation

demonstrate awareness ofprocedures for dealing with the unfitpatient

demonstrate awareness of theadvisory resources that are available.

ability to anticipate effects of flightincluding stress, long haul travel,circadian rhythm changes on bothpatients, travelling companions andself

conduct an assessment oftreatment, accurately, undertake aphysical/mental health examination(as appropriate) and interpretfindings to an enhanced level

ability to initiate specific treatmentprior to transfer

provide training to enhancecompetent nurses assessmentskills.

assess, prioritise, plan, treat andsafely discharge patients presentingfor in-flight repatriation or transfer

evaluate clinical data to select andimplement appropriate care

make operational judgements andprovide advice on all aspects of in-flight care

anticipate the effects to individualsof inflight environment includingtime zones, stress and long haulflights

act as an adviser on whetherpatients and relatives are suitable to fly

give advice and direct policy in therepatriation of patients

ensure that tools and protocolsdesigned for assessment of patientsin the in-flight setting are research-based and current

teach and develop the skills ofothers in the team to ensureeffective, evidence-based care isprovided that reflects up-to-dateguidance relevant to in-flightnursing.


14



Planning, providing and evaluating specific interventions, treatment and therapies

understand and demonstratepractical skills in the logistics of in-flight transfer

relate theory to practice

possess basic life support skills asrecognised by the UKRC/ERC (UKResuscitation Council/EuropeanResuscitation Council ) anddemonstrate competence to usethese in the aeromedicalenvironment

ability to intervene in an emergencybasis while working within the scopeof professional practice

anticipate, perform and evaluateongoing patient assessmentrequirements in the aeromedicalenvironment

ensure that the needs of the patientand travel companions are metduring transfer

demonstrate and maintain expertisein own specialty

demonstrate the medico-legalaspects of in-flight practice.

ability to risk assess critically alogistical transfer and recommendalternatives based on robustevidence and clinical parameters

maintain UKRC/ERC basic lifesupport and hold a UKRCIntermediate Life Support certificateas appropriate to the aeromedicalcare environment

recognise limitations to practice inan emergency and demonstrateawareness of how to give medicaladvice and assistance overseas

ability to co-ordinate others in theevent of a critical situation

demonstrate the ability to assesscritically the medico-legal aspects ofown practice.

demonstrate highly developedspecialist knowledge of the wholerange of the logistics of in-flighttransfer. Demonstrate how to applythis knowledge to highly clinical,and complex situations

possess intermediate/advanced lifesupport skills (as appropriate) asrecognised by the UKRC anddemonstrate competence to usethese in the aeromedicalenvironment

develop and challenge establishedexpertise in own specialty

ensure others work within their ownsphere of practice

educate others to the medico-legaland health and safety aspects of in-flight care provision and practice.



15

Core competency 5: leadership and management in-flight nursing

ability to self-assess competenceusing national in-flightcompetencies, and identifylimitations through lack ofexperience and seek advice andtraining from appropriate sources

demonstrate where to acquireappropriate in-flight nursingknowledge and expertise andsupport and guidance to ensureoptimum appropriate specialistknowledge base

demonstrate a sound knowledge ofcultural, legislative and customsissues related to international traveland aviation procedures

demonstrate the issues aroundfinancial versus clinical aspects ofcare, and demonstrate appropriateskills in discussing and advocatingcare.

ability to build on existingcompetencies and experience andshare knowledge throughnetworking and communicationdirectly with junior and senior staff

be available to support lessexperienced flight nurses andencourage development throughpeer group support and be involvedin specialist educational packages

demonstrate awareness of theresponsibility of the registered in-flight practitioner to report anychanges with known cultural,legislative and customs issues tojunior and senior flight nurses, whilebalancing the confidentiality issuesof care

endorse cost effective practice andcontribute to budgetary issues.

develop systems and auditpackages to ensure more junior andless experienced staff have aconstant source of information,updates and educationalopportunities

ensure all staff are aware ofavailable specialist educationalopportunities related to in-flightcare, and commission training asappropriate

develop up-to-date databases tokeep all staff fully informed ofchanges with cultural, legislativeand customs issues involved in in-flight care

demonstrate budgetarymanagement skills that promotesafe practice within the limitationslaid down by insuranceunderwriters, and be prepared toinfluence change where it may beseen to be unrealistic.


Under the direct supervision of an

expert nurse

Under the minimum guidance and

supervision of an expert nurseWithout guidance or supervision

16


References

Department of Health (2004) The NHS knowledge andskills framework (NHS KSF) and the development reviewprocess, London: DH.

Department of Health (2000) The NHS Plan: a plan forinvestment, a plan for reform, London: DH.

Nursing & Midwifery Council (2004) The NMC code ofprofessional conduct: standards for conduct, performanceand ethics, London: NMC.

Royal College of Nursing (2003) The future nurse: thefuture for nurse education. A discussion paper, London:RCN.

www.rcn.org.uk/downloads/futurenurse/nurse-education.doc

3

July 2008 Review date April 2008 Published by the Royal College of Nursing 20 Cavendish Square London W1G 0RN 020 7409 3333

The RCN represents nurses and nursing, promotes excellence in practice and shapes health policies Publication code 003 141 ISBN 978-1-904114-59-8 Approved by the RCN Accreditation Unit until April 2008

Documents

FLight