Imagine living in a small habitat, isolated and confined due to an extreme and dangerous environment, and without regular communication with the outside world. Now through November 2020, two space architects from the SAGA Space Architects firm in Denmark will conduct LUNARK, a long-duration Moon mission analog project in the Arctic, Greenland. The purpose of LUNARK is to test an innovative habitat, named Aefintyr (adventure in Norse), for future Moon mission suitability. To maximize this opportunity to better understand how human beings are impacted by these challenging and limiting conditions, SAGA Space Architects issued a call for research proposals. I was thrilled when my aerospace nursing research proposal was chosen for this groundbreaking analog mission. My research is aimed at detecting and examining space asthenia. In addition to gaining insight into this poorly understood condition that emerges during spaceflight-associated isolation and confinement and includes multiple physiological, behavioral, and other factors that may adversely impact performance, I hope that this research project underscores the importance of nursing science contributions to all aspects of human health and performance, in every environment in which people live, work, and play.
As Founder and CEO of Minerva Nursing Science, LLC, my goals are to conduct aerospace nursing research and to develop technology that will help enhance human health and performance during long-duration spaceflight. Undoubtedly, these objectives are familiar to nurses, as our common lodestar is to improve outcomes for our patients, families, and communities. It is my firm belief that astronauts—and with the advent of commercial spaceflight, spaceflight tourists—will urgently need and benefit from nursing during spaceflight. As always, evidence will drive nursing care in space, and through Minerva, I hope to contribute to that knowledge base.
The spark of curiosity that leads to nursing research, an evidence base, and ultimately, nursing interventions targeting a specific condition often emerge under wildly different circumstances. I care about space asthenia because of unusual signs and symptoms in a patient I cared for during my undergraduate nursing internship. I was powerless to help her at that time; I lacked both knowledge and experience. That said, I knew that what the patient experienced was important and deserved attention, and I never forgot her. Years later, as a graduate student, I was shocked to see similar signs and symptoms among astronauts in space asthenia literature. Further, I was surprised to learn that space asthenia is not clearly defined by space psychologists or psychiatrists, has no dedicated assessment instrument, and cannot be prevented, diagnosed, or treated. So, I did what any nurse scientist would do: I conducted an evolutionary concept analysis to clarify the concept, derived a theory, and created a model that informed development of a space asthenia-specific questionnaire. This questionnaire will be included in my mixed-methods study conducted during the LUNARK mission.
Why is space asthenia a threat? Should space asthenia develop among crewmembers during long-duration, deep space missions (e.g., to Mars) then mission success and the lives of the astronauts would be at serious risk. This is not a foreign concept. The similarities between the impact of spaceflight and that of the current COVID-19 global pandemic on individuals are marked. Individuals around the world living in isolation and confinement associated with mandatory or voluntary quarantine may experience increased stress, anxiety, depression, decreased motivation, and suboptimal job performance. As much of the United States and other countries around the world grapple with increased COVID-19 cases in the context of phased reopening, people who must or want to venture out are also confronted with navigating environments they may perceive as “hostile,” in which recommended mask-wearing or social distancing is often uneven or lacking. To help prevent and mitigate the negative health and performance effects of the current situation and other medical conditions, accurate assessment and appropriate interventions are critically needed.
It is my hope that the results of my research lead to the translation of my space asthenia assessment tool and future countermeasures to a nursing assessment tool and interventions for individuals experiencing negative health and performance issues associated with isolation, confinement, and extreme or threatening environments. And there is evidence to support my hope for this type of translation! In 2018, we conducted a literature review to explore potential translation of NASA depression countermeasures for use with terrestrial patients. We found that most countermeasures were in the clinical research phase of the National Institutes of Health/National Center for Advancing Translational Sciences spectrum and were ready and highly promising for terrestrial intervention translation and testing.
It is important to note that space health countermeasure translation is not just a one-way endeavor. TRISH, the Translational Research Institute for Space Health at Baylor College of Medicine, is a NASA-supported institute working to identify and fund cutting-edge research and technology that can be adapted for space health countermeasures needed for future Mars missions. TRISH actively seeks disruptive research conducted by those new to space health.
As highly educated, informed, and creative healthcare providers, clinical nurses are well-positioned to recognize novel patient phenomena that require investigation and ultimately, intervention, and are more than capable of contributing to these efforts!
People need nursing, on Earth and in space. I strongly encourage nurses, both scientists and clinicians, to think about the challenges associated with isolation, confinement, extreme environments, and other major risks to health and performance associated with long-duration spaceflight, and consider similar issues confronting their patients. Then partner, seek funding, conduct research, and develop innovative tools, products, and technology for terrestrial patients—all with the potential for translation and future use on the Moon, Mars, and beyond.
Aubrey Florom-Smith, PhD, RN, is the founder and CEO of Minerva Nursing Science, LLC and is a member of Sigma’s Beta Tau Chapter at the University of Miami School of Nursing & Health Studies in Coral Gables, Florida, USA.