Full Text

1 INTRODUCTION

This year marked 60 years since Russian cosmonaut Yuri Gagarin became the first human in space, part of the initial space race between the Soviet Union and the United States. Spaceflight and space exploration have seen a resurgence in recent years with the National Aeronautics and Space Administration (NASA)’s mission to return humans to the moon and ultimately continue to Mars, and the emergence of a new space race in the commercial sector with companies like Virgin Galactic, Blue Origin and SpaceX. This has led to extraordinary developments in relevant engineering and technology, as well as a new group of space travellers paying to fly commercial flights, unconstrained by the rigorous screening and training historically required of professional astronauts. With these breakneck advances, a new segment of the healthcare system should emerge to address the unique challenges of human health in space, moving beyond primarily suborbital flight and low-earth orbit, to lunar settlement and long-duration spaceflight.

Nurses are uniquely poised in the current healthcare profession to provide critical insight and develop systems and protocols to keep our astronauts and citizen space travellers healthy (Rogers, 1992). The need for healthcare development for space is a reality. We have moved beyond science fiction, and the nurse's training, skills, and experience will be valuable in designing and developing healthcare and policies for humans in space.

2 PHYSIOLOGICAL ALTERATIONS WITH SPACE TRAVEL

2.1 Now

A great deal of research has been performed—and is currently underway—on human adaptation to space flight. Nevertheless, compared to much biomedical research on Earth, data and information pertaining to human health in space are relatively limited and disparate, with fewer than 600 humans having travelled to space to date. Space travel thus far has included suborbital flights, like the recent commercial flights with Richard Branson and Jeff Bezos, flights to low-earth orbit, which includes the International Space Station, and lunar missions, like the Apollo moon landings. Much of the research medical has concentrated on the issues inherent to these relatively short-duration flights (up to 1 year on the International Space Station). Attention is now being paid to longer and more ambitious missions like one to Mars, which would entail extreme crew autonomy from Earth assistance, but several key issues for such flights remain crucially under-studied.

Humans have performed at a very high level in space, especially considering the demands of the environment. Still, some primary health risks and adverse health outcomes have emerged as key concerns. NASA has identified five key hazards to human health and performance in space: altered gravity, radiation, isolation and confinement, distance from earth, and a hostile and closed environment (on the spacecraft). These factors can cause a variety of health issues, including heart and muscle atrophy and fluid shift out of the lower extremities due to weightlessness, neuro-ocular alterations and other difficulties possibly due to increased intracranial pressure, development of renal stones, urinary tract infections, alterations in the gut microbiome, loss of bone mass and muscle strength, and depressed or altered mood (Comfort et al., 2021; Demontis et al., 2017; Shen & Frishman, 2019). These issues can not only interfere with functioning and productivity in flight, but they can also cause long-term problems after flight.

With proximity to Earth of space mission to date, astronauts are constantly monitored, and those who have a health problem can directly and immediately consult with specialists on Earth. If there is a true emergency, astronauts can be transported back to Earth for direct medical care in a matter of hours. Furthermore, astronauts endure a comprehensive screening process to identify potential health issues that would disqualify them from space flight.

2.2 Future

When considering long-duration or deep space flights (e.g. 3-year missions to Mars), we have no direct data to consult. Instead, NASA and other organisations will rely on predictive healthcare modelling, by drawing on a variety of resources, including what we know so far, information collected from analog environments, and consultation with a wide group of professionals in the field of human health and space.

Astronauts will continue to experience the same healthcare issues they currently do, in addition to an increased risk for emergency problems (i.e. burns, broken bones, infection), all of which will need to be addressed independent of direct Earth consultation or support.

Before launch, astronauts on these early long-duration missions will likely receive the highest and most sophisticated level of personalised and predictive medicine, including genetic mapping to screen for diseases and pharmacodynamics. Even with this level of proactive care, we can assume that astronauts may encounter serious or emergent health issues in flight. Treatment and care will largely be crew-directed and executed. Without the ability for real-time contact with Earth, the crew will need to be prepared to diagnose, treat and care for an injured crewmember on their own using what is available on the spacecraft. This will entail a need for more frequent and robust health assessments, long-term care, or even palliative care if one of the crew experiences a medical emergency for which they are unequipped to resolve. The healthcare burden on astronauts in these missions will be larger than in the past, and they will need to be physically and mentally prepared for the most extreme adverse consequences.

The Federal Aviation Administration (FAA) requires commercial space flights to provide a minimum of fourteen hours of pre-flight training for all space travellers. Flight fitness testing, physical and psychological, remains up to the company's discretion, which means standards for space flight could be drastically different from those of astronauts. As commercial flight and the ‘space tourism’ industry evolve past suborbital flight to include moon landings and space hotels, healthcare support will be needed to assist those travellers with lower levels of fitness and flight training than in their professional counterparts. This could include managing chronic health issues like high blood pressure or diabetes or addressing acute care needs like infections, bone fractures or unidentified cardiac arrhythmias. As commercial spaceflight becomes more common, companies may begin to distinguish themselves with high-quality customer care, which will include comprehensive medical support.

3 SPACE NURSING

Nurses have been involved in aerospace medicine even before the existence of human spaceflight. Delores (Dee) O’Hara was the first nurse to assist with health maintenance of astronauts on the ground, and she receives special recognition because astronauts in some cases entrusted her with their medical problems rather than the flight surgeons (physicians). In the early days of American space flight, nurses were considered to be assistants to physicians. Over the years, nurses have been involved in research at space centres. Commercial sectors like SpaceX are now seeking space operations nurses to work with a multidisciplinary team, including the areas of human spaceflight public health and occupational medicine. Space nursing could be defined as a specialty in which nurses use critical thinking and judgement to integrate objective data with subjective experience taking a holistic approach to managing symptoms and improving the well-being of individuals travelling into space. This may involve educating space travellers on self-care, health promotion and disease prevention, under circumstances where they may not easily be able to return to Earth. In addition, nurses can help space travellers to build resiliency amidst isolation and extreme environmental conditions.

4 TRANSFORMING HEALTH CARE FOR SPACE FLIGHTS

Nurses have unique patient-centred clinical expertise that positions them well to transform the current healthcare provided to space travellers (Rogers, 1992). Expertise in primary care, health promotion, mental health, disease prevention and palliative care can aid in managing pre-existing comorbidities, increasing personal resilience, controlling the spread of infection, and facilitating end-of-life care while access back to Earth might be limited. Nursing specialties, including critical care, flight, wilderness, psychiatric, public health, palliative and home-care nurses, have unique clinical decision-making and skillsets that can advance healthcare in space and make space travel more accessible for civilians. Nurses can also educate crewmembers on how to apply critical care nursing for their crewmates in case of an emergency, or, in extenuating medical circumstances, palliative care skills that may be needed in the limited-resource setting of a space shuttle. Nurse managers and administrators could not only assist with healthcare needs but also assume operational leadership roles overseeing the tasks for the crew launch and recovery.

5 FUTURE OF NURSING IN SPACE

Data suggesting that nursing is the most trusted profession in the healthcare industry should encourage both NASA and commercial sectors to include nurses in the health screening, education on self-management of comorbidities, promotion of mental health, and acute and palliative care of space travellers. It is imperative that nursing schools and nurse educators incorporate space health into nursing curricula to ensure that nurses are ready for future healthcare needs. Discussions need to begin on how space health can be incorporated into the curricula in the form of a certificate programme or an entire specialty as space traffic builds momentum. In addition, nurses need to expand research in understanding the symptoms associated with changes in gravity and how they can be managed efficiently. This will require reprioritising funding goals in nursing. Finally, nurses must have a seat at the healthcare decision for space flight to optimise decisions and plans established to make space travel safe and appealing, and nurses need to take the lead in promoting space travellers’ health.

全文翻譯（僅供參考）

1 介紹

今年是俄羅斯宇航員尤里·加加林成為第一個(gè)進(jìn)入太空的人類 60 周年，這是蘇聯(lián)和美國之間最初的太空競(jìng)賽的一部分。近年來，隨著美國國家航空航天局 (NASA) 的使命是將人類送回月球并最終繼續(xù)前往火星，以及商業(yè)領(lǐng)域與公司的新太空競(jìng)賽的出現(xiàn)，太空飛行和太空探索已經(jīng)復(fù)蘇比如維珍銀河、藍(lán)色起源和SpaceX。這導(dǎo)致了相關(guān)工程和技術(shù)的非凡發(fā)展，以及一群新的太空旅行者支付商業(yè)飛行費(fèi)用，不受專業(yè)宇航員歷來所需的嚴(yán)格篩選和培訓(xùn)的限制。有了這些突如其來的進(jìn)步，

護(hù)士在當(dāng)前的醫(yī)療保健行業(yè)中處于獨(dú)特的地位，可以提供重要的洞察力并開發(fā)系統(tǒng)和協(xié)議，以保持我們的宇航員和公民太空旅行者的健康（羅杰斯，1992 年）。對(duì)太空醫(yī)療保健發(fā)展的需求是一個(gè)現(xiàn)實(shí)。我們已經(jīng)超越了科幻小說，護(hù)士的培訓(xùn)、技能和經(jīng)驗(yàn)將在為太空人類設(shè)計(jì)和制定醫(yī)療保健和政策方面很有價(jià)值。

2 太空旅行帶來的生理變化

2.1 現(xiàn)在

已經(jīng)進(jìn)行了大量關(guān)于人類適應(yīng)太空飛行的研究，目前正在進(jìn)行中。然而，與地球上的許多生物醫(yī)學(xué)研究相比，與太空人類健康有關(guān)的數(shù)據(jù)和信息相對(duì)有限且各不相同，迄今為止，只有不到 600 人前往太空。迄今為止的太空旅行包括亞軌道飛行，例如最近與理查德布蘭森和杰夫貝索斯的商業(yè)飛行，飛往低地球軌道的飛行，包括國際空間站，以及月球任務(wù)，如阿波羅登月。許多醫(yī)學(xué)研究都集中在這些相對(duì)短時(shí)飛行（在國際空間站長達(dá) 1 年）固有的問題上?，F(xiàn)在人們開始關(guān)注更長時(shí)間和更雄心勃勃的任務(wù)，比如去火星，

人類在太空中的表現(xiàn)非常高，特別是考慮到環(huán)境的要求。盡管如此，一些主要的健康風(fēng)險(xiǎn)和不利的健康結(jié)果已成為關(guān)鍵問題。NASA 已經(jīng)確定了人類在太空中的健康和表現(xiàn)的五個(gè)主要危害：改變的重力、輻射、隔離和限制、與地球的距離以及敵對(duì)和封閉的環(huán)境（在航天器上）。這些因素會(huì)導(dǎo)致各種健康問題，包括心臟和肌肉萎縮以及由于失重導(dǎo)致下肢體液轉(zhuǎn)移、神經(jīng)眼部改變和其他可能由于顱內(nèi)壓升高、腎結(jié)石形成、尿路感染、腸道微生物組的改變、骨量和肌肉力量的喪失，以及情緒低落或改變（Comfort 等，2021 年；Demontis 等人， 2017 年；沉和弗里斯曼， 2019 年）。這些問題不僅會(huì)干擾飛行中的功能和生產(chǎn)力，而且還會(huì)在飛行后導(dǎo)致長期問題。

迄今為止，由于太空任務(wù)離地球很近，宇航員會(huì)受到持續(xù)監(jiān)測(cè)，那些有健康問題的人可以直接和立即咨詢地球上的專家。如果真的發(fā)生緊急情況，宇航員可以在幾個(gè)小時(shí)內(nèi)被運(yùn)回地球接受直接醫(yī)療。此外，宇航員還要接受全面的篩查過程，以確定可能導(dǎo)致他們無法參加太空飛行的潛在健康問題。

2.2 未來

在考慮長期或深空飛行（例如，為期 3 年的火星任務(wù)）時(shí)，我們沒有可參考的直接數(shù)據(jù)。相反，NASA 和其他組織將依靠預(yù)測(cè)性醫(yī)療保健建模，通過利用各種資源，包括我們目前所知道的、從模擬環(huán)境收集的信息以及與人類健康和空間領(lǐng)域的廣泛專業(yè)人士的協(xié)商.

除了緊急問題（即燒傷、骨折、感染）的風(fēng)險(xiǎn)增加之外，宇航員將繼續(xù)面臨與目前相同的醫(yī)療保健問題，所有這些問題都需要獨(dú)立于直接的地球咨詢或支持來解決。

在發(fā)射之前，執(zhí)行這些早期長期任務(wù)的宇航員可能會(huì)接受最高和最復(fù)雜的個(gè)性化和預(yù)測(cè)醫(yī)學(xué)，包括用于篩查疾病和藥效學(xué)的基因圖譜。即使有這種程度的主動(dòng)護(hù)理，我們也可以假設(shè)宇航員在飛行中可能會(huì)遇到嚴(yán)重或緊急的健康問題。治療和護(hù)理將主要由船員指導(dǎo)和執(zhí)行。如果沒有與地球?qū)崟r(shí)聯(lián)系的能力，機(jī)組人員將需要準(zhǔn)備好使用航天器上可用的設(shè)備自行診斷、治療和照顧受傷的機(jī)組人員。如果其中一名船員遇到他們無法解決的醫(yī)療緊急情況，這將需要進(jìn)行更頻繁和有力的健康評(píng)估、長期護(hù)理，甚至姑息治療。

美國聯(lián)邦航空管理局 (FAA) 要求商業(yè)太空飛行為所有太空旅行者提供至少 14 小時(shí)的飛行前培訓(xùn)。飛行健康測(cè)試，身體和心理，仍然由公司自行決定，這意味著太空飛行的標(biāo)準(zhǔn)可能與宇航員的標(biāo)準(zhǔn)大不相同。隨著商業(yè)飛行和“太空旅游”行業(yè)從亞軌道飛行發(fā)展到包括登月和太空旅館，將需要醫(yī)療支持來幫助那些體能和飛行訓(xùn)練水平低于專業(yè)同行的旅行者。這可能包括管理高血壓或糖尿病等慢性健康問題，或解決感染、骨折或不明身份的心律失常等急性護(hù)理需求。

3 空間護(hù)理

甚至在載人航天飛行之前，護(hù)士就已經(jīng)參與了航天醫(yī)學(xué)。Delores (Dee) O'Hara 是第一位在地面協(xié)助宇航員健康維護(hù)的護(hù)士，她得到了特殊的認(rèn)可，因?yàn)樵谀承┣闆r下，宇航員將他們的醫(yī)療問題委托給了她，而不是飛行外科醫(yī)生（醫(yī)師）。在美國太空飛行的早期，護(hù)士被認(rèn)為是醫(yī)生的助手。多年來，護(hù)士一直參與太空中心的研究。SpaceX 等商業(yè)部門現(xiàn)在正在尋找太空運(yùn)營護(hù)士與多學(xué)科團(tuán)隊(duì)合作，包括載人航天公共衛(wèi)生和職業(yè)醫(yī)學(xué)領(lǐng)域。太空護(hù)理可以定義為護(hù)士使用批判性思維和判斷將客觀數(shù)據(jù)與主觀經(jīng)驗(yàn)相結(jié)合的專業(yè)，采用整體方法來管理癥狀并改善進(jìn)入太空的個(gè)人的福祉。這可能涉及對(duì)太空旅行者進(jìn)行自我保健、健康促進(jìn)和疾病預(yù)防方面的教育，因?yàn)樗麄兛赡軣o法輕易返回地球。此外，護(hù)士可以幫助太空旅行者在與世隔絕和極端環(huán)境條件下建立彈性。在他們可能無法輕易返回地球的情況下。此外，護(hù)士可以幫助太空旅行者在與世隔絕和極端環(huán)境條件下建立彈性。在他們可能無法輕易返回地球的情況下。此外，護(hù)士可以幫助太空旅行者在與世隔絕和極端環(huán)境條件下建立彈性。

4 改變太空飛行的醫(yī)療保健

護(hù)士擁有獨(dú)特的以患者為中心的臨床專業(yè)知識(shí)，可以很好地改變當(dāng)前提供給太空旅行者的醫(yī)療保健 (Rogers, 1992）。在初級(jí)保健、健康促進(jìn)、心理健康、疾病預(yù)防和姑息治療方面的專業(yè)知識(shí)可以幫助管理先前存在的合并癥、提高個(gè)人復(fù)原力、控制感染的傳播以及促進(jìn)臨終關(guān)懷，同時(shí)返回地球有限的。護(hù)理專業(yè)，包括重癥監(jiān)護(hù)、飛行、荒野、精神病學(xué)、公共衛(wèi)生、姑息治療和家庭護(hù)理護(hù)士，擁有獨(dú)特的臨床決策和技能組合，可以促進(jìn)太空醫(yī)療保健并使平民更容易進(jìn)行太空旅行。護(hù)士還可以教育機(jī)組人員如何在緊急情況下為他們的機(jī)組人員應(yīng)用重癥監(jiān)護(hù)護(hù)理，或者在有情有可原的醫(yī)療情況下，在航天飛機(jī)資源有限的環(huán)境中可能需要姑息護(hù)理技能。

5 太空護(hù)理的未來

數(shù)據(jù)表明，護(hù)理是醫(yī)療保健行業(yè)最值得信賴的職業(yè)，應(yīng)鼓勵(lì) NASA 和商業(yè)部門將護(hù)士納入健康篩查、合并癥自我管理教育、促進(jìn)心理健康以及太空旅行者的急性和姑息治療。護(hù)士學(xué)校和護(hù)士教育工作者必須將空間健康納入護(hù)理課程，以確保護(hù)士為未來的醫(yī)療保健需求做好準(zhǔn)備。需要開始討論如何隨著空間交通的發(fā)展勢(shì)頭以證書計(jì)劃或整個(gè)專業(yè)的形式將空間健康納入課程。此外，護(hù)士需要擴(kuò)大研究以了解與重力變化相關(guān)的癥狀以及如何有效管理這些癥狀。這將需要重新確定護(hù)理資助目標(biāo)的優(yōu)先級(jí)。最后，護(hù)士必須在太空飛行的醫(yī)療保健決策中占有一席之地，以優(yōu)化為使太空旅行安全和有吸引力而制定的決策和計(jì)劃，護(hù)士需要帶頭促進(jìn)太空旅行者的健康。

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