作者：NursingResearch護理研究前
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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 2.1.1 Overview
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.
2.1.2 Health issues
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.
2.1.3 Treatment and care
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 2.2.1 Overview
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.
2.2.2 Health issues
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.
2.2.3 Treatment and care
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.
2.2.4 Commercial space flight
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.
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1 介紹
今年是俄羅斯宇航員尤裡·加加林成為第一個進入太空的人類 60 周年，這是蘇聯和美國之間最初的太空競賽的一部分。
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並最終繼續前往火星，以及商業領域與公司的新太空競賽的出現，太空飛行和太空探索已經復蘇比如維珍銀河、藍色起源和SpaceX。
這導致了相關工程和技術的非凡發展，以及一群新的太空旅行者支付商業飛行費用，不受專業宇航員歷來所需的嚴格篩選和培訓的限制。
有了這些突如其來的進步，
護士在當前的醫療保健行業中處於獨特的地位，可以提供重要的洞察力並開發系統和協議，以保持我們的宇航員和公民太空旅行者的健康《羅傑斯，1992 年》。
對太空醫療保健發展的需求是一個現實。
我們已經超越了科幻小說，護士的培訓、技能和經驗將在為太空人類設計和制定醫療保健和政策方面很有價值。
2 太空旅行帶來的生理變化 2.1 現在 2.1.1 概述
已經進行了大量關於人類適應太空飛行的研究，目前正在進行中。
然而，與地球上的許多生物醫學研究相比，與太空人類健康有關的數據和信息相對有限且各不相同，迄今為止，隻有不到 600 人前往太空。
迄今為止的太空旅行包括亞軌道飛行，例如最近與理查德佈蘭森和傑夫貝索斯的商業飛行，飛往低地球軌道的飛行，包括國際空間站，以及月球任務，如阿波羅登月。
許多醫學研究都集中在這些相對短時飛行《在國際空間站長達 1 年》固有的問題上。
現在人們開始關注更長時間和更雄心勃勃的任務，比如去火星，
2.1.2健康 問題
人類在太空中的表現非常高，特別是考慮到環境的要求。
盡管如此，一些主要的健康風險和不利的健康結果已成為關鍵問題。
NASA 已經確定了人類在太空中的健康和表現的五個主要危害：改變的重力、輻射、隔離和限制、與地球的距離以及敵對和封閉的環境《在航天器上》。
這些因素會導致各種健康問題，包括心臟和肌肉萎縮以及由於失重導致下肢體液轉移、神經眼部改變和其他可能由於顱內壓升高、腎結石形成、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；沉和弗裡斯曼， 2019 年》。
這些問題不僅會幹擾飛行中的功能和生產力，而且還會在飛行後導致長期問題。
2.1.3治療 和護理
迄今為止，由於太空任務離地球很近，宇航員會受到持續監測，那些有健康問題的人可以直接和立即咨詢地球上的專家。
如果真的發生緊急情況，宇航員可以在幾個小時內被運回地球接受直接醫療。
此外，宇航員還要接受全面的篩查過程，以確定可能導致他們無法參加太空飛行的潛在健康問題。
2.2 未來 2.2.1 概述
在考慮長期或深空飛行《例如，為期 3 年的火星任務》時，我們沒有可參考的直接數據。
相反，NASA 和其他組織將依靠預測性醫療保健建模，通過利用各種資源，包括我們目前所知道的、從模擬環境收集的信息以及與人類健康和空間領域的廣泛專業人士的協商.
2.2.2健康 問題
除了緊急問題《即燒傷、骨折、感染》的風險增加之外，宇航員將繼續面臨與目前相同的醫療保健問題，所有這些問題都需要獨立於直接的地球咨詢或支持來解決。
2.2.3治療 和護理
在發射之前，執行這些早期長期任務的宇航員可能會接受最高和最復雜的個性化和預測醫學，包括用於篩查疾病和藥效學的基因圖譜。
即使有這種程度的主動護理，我們也可以假設宇航員在飛行中可能會遇到嚴重或緊急的健康問題。
治療和護理將主要由船員指導和執行。
如果沒有與地球實時聯系的能力，機組人員將需要準備好使用航天器上可用的設備自行診斷、治療和照顧受傷的機組人員。
如果其中一名船員遇到他們無法解決的醫療緊急情況，這將需要進行更頻繁和有力的健康評估、長期護理，甚至姑息治療。
2.2.4商業 航天
美國聯邦航空管理局 (FAA) 要求商業太空飛行為所有太空旅行者提供至少 14 小時的飛行前培訓。
飛行健康測試，身體和心理，仍然由公司自行決定，這意味著太空飛行的標準可能與宇航員的標準大不相同。
隨著商業飛行和『太空旅遊』行業從亞軌道飛行發展到包括登月和太空旅館，將需要醫療支持來幫助那些體能和飛行訓練水平低於專業同行的旅行者。
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理需求。
3 空間護理
甚至在載人航天飛行之前，護士就已經參與了航天醫學。
Delores (Dee) O’Hara 是第一位在地面協助宇航員健康維護的護士，她得到了特殊的認可，因為在某些情況下，宇航員將他們的醫療問題委托給了她，而不是飛行外科醫生《醫師》。
在美國太空飛行的早期，護士被認為是醫生的助手。
多年來，護士一直參與太空中心的研究。
SpaceX 等商業部門現在正在尋找太空運營護士與多學科團隊合作，包括載人航天公共衛生和職業醫學領域。
太空護理可以定義為護士使用批判性思維和判斷將客觀數據與主觀經驗相結合的專業，采用整體方法來管理症狀並改善進入太空的個人的福祉。
這可能涉及對太空旅行者進行自我保健、健康促進和疾病預防方面的教育，因為他們可能無法輕易返回地球。
此外，護士可以幫助太空旅行者在與世隔絕和極端環境條件下建立彈性。
在他們可能無法輕易返回地球的情況下。
此外，護士可以幫助太空旅行者在與世隔絕和極端環境條件下建立彈性。
在他們可能無法輕易返回地球的情況下。
此外，護士可以幫助太空旅行者在與世隔絕和極端環境條件下建立彈性。
4 改變太空飛行的醫療保健
護士擁有獨特的以患者為中心的臨床專業知識，可以很好地改變當前提供給太空旅行者的醫療保健 (Rogers，1992》。
在初級保健、健康促進、心理健康、疾病預防和姑息治療方面的專業知識可以幫助管理先前存在的合並症、提高個人復原力、控制感染的傳播以及促進臨終關懷，同時返回地球有限的。
護理專業，包括重症監護、飛行、荒野、精神病學、公共衛生、姑息治療和家庭護理護士，擁有獨特的臨床決策和技能組合，可以促進太空醫療保健並使平民更容易進行太空旅行。
護士還可以教育機組人員如何在緊急情況下為他們的機組人員應用重症監護護理，或者在有情有可原的醫療情況下，在航天飛機資源有限的環境中可能需要姑息護理技能。
5 太空護理的未來
數據表明，護理是醫療保健行業最值得信賴的職業，應鼓勵 NASA 和商業部門將護士納入健康篩查、合並症自我管理教育、促進心理健康以及太空旅行者的急性和姑息治療。
護士學校和護士教育工作者必須將空間健康納入護理課程，以確保護士為未來的醫療保健需求做好準備。
需要開始討論如何隨著空間交通的發展勢頭以證書計劃或整個專業的形式將空間健康納入課程。
此外，護士需要擴大研究以了解與重力變化相關的症狀以及如何有效管理這些症狀。
這將需要重新確定護理資助目標的優先級。
最後，護士必須在太空飛行的醫療保健決策中占有一席之地，以優化為使太空旅行安全和有吸引力而制定的決策和計劃，護士需要帶頭促進太空旅行者的健康。
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