Brushing teeth and rinsing one's mouth—actions taken for granted when healthy must be a great struggle when bedridden. If you cannot sit up on your own, you have no choice but to turn your head to the side and spit out the water in your mouth.

Basins for rinsing (gargle basins) are commercially available. However, most are designed assuming the user is sitting up, making them difficult for bedridden people to use, often resulting in water trickling down to the neck.

Each instance is a small "discomfort". But if it continues, one might become reluctant to receive tooth-brushing care itself. This is despite the fact that daily oral care is essential, considering the risk of aspiration pneumonia.

Professor Miyagawa has faced these "troubles" on the front lines of care from an engineering perspective.

"For example, we use a 3D printer to make a gargle basin that fits the shape of a bedridden patient's mouth. By receiving comfortable care and becoming positive about oral care, the risk of aspiration pneumonia can be reduced. Making tools leads to care."

Instead of fitting care to ready-made products, fit the tools to the method of care—with this "paradigm shift" as an ideal, Professor Miyagawa started the "FabNurse" project in 2015. It is attracting attention both in Japan and abroad as an attempt to actively introduce manufacturing technology utilizing digital fabrication tools like 3D printers into nursing and caregiving settings.

However, the path to getting there was not easy.

"I was a complete amateur regarding nursing", says Professor Miyagawa flatly. She originally studied business administration at Hitotsubashi University and started her career in the world of Operations Research (OR), which applies computer science. The background behind her shift from an interest in building corporate information systems to the entirely different field of nursing was the Great Hanshin-Awaji Earthquake.

"During a disaster, the information truly needed is not in a database, but in the place where something is happening—that is, in the clinical setting. The moment I realized that, my interest shifted from corporations to the front lines."

The turning point came in 2001, when she became involved in education and research as a full-time lecturer specializing in IT with the establishment of the Keio University Faculty of Nursing and Medical Care. Professor Miyagawa would suffer from an unexpected "language barrier".

She says that as an IT specialist, she could not intuitively understand the meaning of the word "yorisou (being close to/accompanying someone)", which should be the most essential concept for nursing experts.

The first trial was the "e-Care Town Project", a campus-wide initiative at the Shonan Fujisawa Campus (SFC) starting in 2002. In collaboration with Fujisawa City and telecommunications companies, they conducted demonstration experiments for a system to support regional care using IT, such as remote consultations by medical professionals and sharing health data. However, communication on the ground just wouldn't go smoothly.

"The IT team's goal was how efficient care could become. We thought it was enough if information could be exchanged online, but medical professionals and patients said that, for example, in online consultations, it was hard to communicate because eye contact wasn't made through the camera."

What is good care? What gradually became clear over time was the fact that the premises were different to begin with. In the field of care, the shortest path to a result is not necessarily the optimal solution. "Being close" is a means to realize "well-being" for that person to live better, and even if it takes time and effort, it is a meaningful act if it is a necessary interaction for that person.

"By acknowledging that we didn't understand each other, a dialogue about 'what each other's purpose is' finally began. In the end, it took 10 years to understand."

Eventually, this realization became the axis of Professor Miyagawa's research.

Professor Miyagawa's driving force is her respect for the "super cool ingenuity" of nurses who have supported patients by using their wisdom.

For example, wheelchair brakes are usually on the right side, assuming operation with the right hand. But for someone with paralysis on the right side of their body, this is not easy. In one nursing setting, an ingenuity was applied by attaching a plastic wrap core to the lever to make it longer, allowing it to be operated with the left hand. It was a simple modification, but the small ingenuity supported daily movements and improved the user's quality of life.

"When I saw this, I got goosebumps. If ready-made products are hard to use, solve it with creativity on the spot. This is exactly the 'emerging innovation' of the clinical front lines. However, it's such a waste for this ingenuity to end as a 'one-off'. I want to deliver this know-how to people all over the world—that is my starting point."

Is there a way to widely disseminate front-line ingenuity while ensuring safety and design? A tailwind was the 3D printer, which was under development at the time.

It was introduced at Keio University's Shonan Fujisawa Campus (SFC) around 2013, creating an environment where students and faculty could use it freely. At the timing when technology advanced to handle soft materials, Professor Miyagawa sought cooperation from Professor Hiroya Tanaka of the Faculty of Environment and Information Studies at the same university, a leading expert in this field.

"In hospitals, beds and equipment are of the same standard, but in home care, bed sizes and outlet positions vary. Considering the individuality of the living environment and the patient's condition, I thought home care would be compatible with digital fabrication", says Professor Miyagawa.

In 2022, she developed a "manual fecal extraction practice simulator" together with Professor Shingo Maeda and others from the Tokyo Institute of Technology (now Institute of Science Tokyo), who are involved in the development of soft robots.

"Manual fecal extraction" is a procedure to encourage defecation by inserting a finger into the anus and stimulating the rectum. Among elderly people receiving home care, 60% feel difficulty with defecation. There are many situations where defecation care is required. However, because it involves private parts, it is difficult for veteran nurses to show examples or for novices to train in advance.

Professor Miyagawa, who received a consultation from a graduate involved in home-visit nursing, used soft robot technology to create a "manual fecal extraction practice simulator" that can reproduce the sensory feeling of "if I move my finger like this, this kind of reaction comes back" with a touch close to a living body.

"I'm not doing anything myself. I'm just connecting things", says Professor Miyagawa, but as a rare "translator" moving between different fields, she is opening up new possibilities for care by connecting the needs of the nursing front lines with engineering technology, or research with practice.

Alongside manufacturing, she is also working on information management during disasters.

"Information becomes extremely important during disasters. Management is necessary to ensure support reaches everyone, and for that, it is essential to understand the needs of what is needed where and how much. That leads to disaster mitigation care and later to life reconstruction."

During the 2011 Great East Japan Earthquake, she traveled to the disaster areas many times to deliver PCs and printers that were lacking in evacuation centers. She also opened PC classes to help disaster victims return to work. Furthermore, she proposed a mark-sheet style victim assessment form as a tool for volunteer nurse teams to understand the health needs of victims. She automated everything from data reading to tabulation, reducing the burden on nurses to manually input data.

In 2015, she established the "IT Disaster Assistance and Response Team (IT DART)". She has continued activities to support care through the collection and sharing of information, such as visualizing the support status on maps during the 2016 Kumamoto Earthquake and the 2018 Western Japan Heavy Rain Disaster.

During the 2024 Noto Peninsula Earthquake, she provided information management support at evacuation centers in Kanazawa City for three months. There, she witnessed situations where care information for victims moving from primary evacuation centers to secondary evacuation centers and then to temporary housing was not being handed over well.

"Information cannot keep up with the movement of people. For example, if information that a person has a high risk of falling is shared promptly, they can receive continuous care such as rehabilitation and the installation of handrails even after moving from an evacuation center to temporary housing. If information sharing takes time and care is interrupted for just two weeks, ADL (Activities of Daily Living) will decline."

However, Professor Miyagawa says that an information system alone does not solve everything.

"The point is the 'roles'—what kind of people are in that community and what roles they play. And the 'rules' for realizing each individual's well-being—so to speak, the care policy and way of involvement. It only functions when the three elements of 'roles', 'rules', and 'tools (information systems)' are all present."

The "future" of nursing envisioned by Professor Miyagawa lies beyond mere digitalization.

In Japan in 2040, the annual number of deaths will reach 1.68 million, and securing places for end-of-life care—where and how one meets the end—will become a major issue.

In such an era, the capacity of hospitals and elderly facilities will reach its limit. Professor Miyagawa believes it will be an era to think about well-being (living better) and well-dying (concluding life better) at home.

"Since the number of people involved in caregiving and home care will also plateau, in order to provide better care with a limited number of people, it is necessary for the front lines to become creative in addition to improving individual skills."

What Professor Miyagawa envisions is a form of care with AI as a partner, centered on interactions that only humans can do.

"The essence of nursing is, after all, 'human.' There is care that can only be born by sensing with one's own body and interacting as a person. The role of AI is to take over the other parts. To enable nurses to face care more humanly. That is what AI should be used for."

On the other hand, she says the value of "accompanying care (yorisou care)" that Japanese nursing prides itself on will become increasingly important in the nursing of the future.

"This 'being close' is the value that Japanese care can show to the world. The role of the nursing profession in supporting both the person who is passing away and the family seeing them off will not change."

With that, Professor Miyagawa speaks of her outlook.

"By bridging with technology, we can create new care. Not just the person receiving care, but nurses, families, and engineers—everyone cooperates to create a better form of care... I want to create such an exciting future together with all of you."

Composition: Toru Tamakawa, Editor-in-Chief of Asahi Shimbun GLOBE+

Reporting/Writing: Maiko Watanabe

Photography: Hiromi Shinada