The Fab Nurse Project

After working as a nurse for about five years, I enrolled in the master's program at the Graduate School of Media and Governance as a working adult. I am currently a member of the Hiroya Tanaka Lab , where I research monozukuri (the art of making things). In particular, I am focused on a project called " Fab Nurse ," which explores how to utilize digital fabrication in the field of nursing.

Before entering graduate school, I had the opportunity to conduct joint research between the home-visit nursing station where I worked and Keio University. The research examined how 3D printers could be used in medical settings, and I was involved while working as a home-visit nurse.

What I realized then was that the power of monozukuri could solve problems that were difficult or impossible to address with nursing skills alone. I felt that by providing support through the power of design and engineering, we could offer better care to patients. This desire to delve deeper into research in that field led me to enroll in the Graduate School of Media and Governance.

"Fab Nurse" is a research project aimed at improving nursing environments using a monozukuri technology called "digital fabrication."

"Digital fabrication" is a technology that uses tools like 3D printers to create necessary items in the required form to meet individual needs. In nursing, where it is essential to address each patient's specific condition and challenges, I believe that utilizing this technology of "making things tailored to the individual" can provide better support.

In recent years, initiatives using 3D printers have been increasing in the medical field as a whole, but there are very few examples of monozukuri being applied in the context of nursing. With "Fab Nurse," we start by considering how monozukuri technology can be used in nursing settings and then conduct verification for its continuous use.

The first thing I made was a support tool for writing, known as a "self-help device," for a patient I was in charge of when I was still working as a home-visit nurse.

This person had damaged a nerve in their neck in a traffic accident, which confined them to a wheelchair. Although they could raise their arms, they couldn't grip their hands and were unable to hold a pen firmly. The existing self-help devices they had been using had limitations, making it difficult to write clearly and forcefully. By using a 3D printer to create a device perfectly tailored to them, they were able to write much more firmly, and they were extremely happy.

Being able to write is directly linked to social participation. If you can't write clearly, it becomes difficult to sign important documents, and you may have to rely on others for necessary daily activities like receiving packages or mail. I realized that monozukuri can solve these barriers to social reintegration and support patients' lives.

Since I was continuously visiting that patient's home, I was able to see them use the self-help device for a long time afterward. I heard them say things like, "I can't sign without this," and "I use it for studying and taking notes." This made me strongly feel that monozukuri technology was changing their expression and their life. Seeing something I made and provided being used continuously and changing a patient's life was an experience I hadn't often had even as a nurse, so I was very happy.

I also created a practice device for suctioning. For patients who have difficulty breathing due to conditions like lung cancer and have lost the strength to cough up phlegm, there is a care procedure that involves inserting a straw-like tube through the nose to suction the phlegm. When phlegm gets stuck, patients using home-visit nursing have to wait for the nurse to arrive, and even if family members want to help ease their breathing, they can't without experience.

So, I created a device that allows them to practice this suctioning. It's a model of a human head that lets you insert a tube into the nose and see how far it has gone in. While its actual implementation is still to come, I hope that this device will help nursing students and patients' families get a feel for the procedure.

We are also attempting to create care products that are perfectly suited to the individual. We are making a bowl-shaped container called a gargle basin, used for spitting out the contents of the mouth after gargling.

Off-the-shelf containers don't fit well for people who have become emaciated or lack the strength to spit, and what they spit out can sometimes leak from the sides. This can lead to having to change soiled clothes or damage the person's self-esteem. To reduce this as much as possible, we scan the person's face with a 3D scanner and create a perfectly fitted basin from a soft material that can be used even when pressed against the face.

It is currently in the empirical research phase, where we are having patients actually use it and provide feedback. In addition to reducing the burden on the patients themselves, we hope that by preventing situations like needing to change clothes, we can help alleviate the nursing staff shortage and reduce the burden on families, even if just a little.

In addition, we are also conducting parallel evaluations of the safety and durability of these 3D-printed items for use in medical settings. How to maintain cleanliness when using created items in a medical environment is extremely important. We are also creating things like safety evaluation flows for medical settings, which assess whether materials can withstand washing, disinfection, and sterilization, and check their durability.

The nursing field is a place where a great deal of ingenuity is required to improve the quality of care. For example, for someone who has difficulty gripping, we make adjustments for daily living, such as attaching strings to everyday objects like cushions or remote controls so they can be pulled.

In that sense, nursing is actually a very creative field where various ideas and innovations are born daily and can be put into practice. However, at present, there are still few situations where these ideas are actually embodied as "things." That's why I thought that by applying monozukuri technology, various possibilities could emerge.

The home-visit nursing setting where I worked, in particular, was a place where patients' living environments varied completely from one household to another, requiring us to devise solutions accordingly. In a hospital, the room structure is somewhat fixed, and the positions of necessary equipment around the bed are standardized. But in home-visit nursing, since we visit the patient's home, there are tatami rooms and rooms with beds, and the challenges in daily life are completely different, requiring more individualized support.

As the number of people needing nursing care at home is expected to increase, one of the goals of the "Fab Nurse" project is to support the care environment with the power of monozukuri.

Currently, in the medical field, about 80% of people die in hospitals, with the remaining 20% dying at home or in other locations. It is said that this ratio will change in the future, with more people spending their final moments at home. By 2035, the number of "end-of-life care refugees"—people who cannot receive appropriate medical care—is projected to increase to 70,000.

One factor is the shortage of beds in medical facilities, but a major issue is the absolute shortage of medical and nursing staff relative to the number of people passing away. Human resources, a precious medical resource, are limited.

Currently, a home-visit nurse's visit to a patient's home typically takes about one hour. By providing the kind of support we are working on with "Fab Nurse," families might be able to perform suctioning, or the manpower needed for changing clothes could be reduced. This might cut a one-hour visit down to 30 minutes. By accumulating such efforts, perhaps even one more person can face their end of life while receiving optimal care. We hope to contribute to support that makes this possible.

First, there's the ability to conduct research that "bridges disciplines." I think being able to advance research across multiple fields is a major feature.

Furthermore, the fact that it is "accompanied by practice" is also a crucial point.

It doesn't end with armchair theory; the goal is practical application, and you only get evaluated once you take it to a clinical setting. For example, in our lab, we don't just stop at making something. We advance our research by having users like patients, nurses, and medical staff use it and by getting feedback from people on the ground. The ability to pursue such practice-oriented research is a great appeal of the Graduate School of Media and Governance.

On top of that, there's an atmosphere where it's normal to be doing something different from others, and I think there are a lot of people researching what they love.

To begin with, there are hardly any places, domestically or internationally, where you can research the unusual combination of nursing and monozukuri. But here, you can tackle it freely. If SFC's Graduate School of Media and Governance didn't exist, I don't know if I would have been able to do this research (laughs).

I like the lofts in the graduate school building because I can work there very calmly. Also, the incredibly fast internet is a plus (laughs).

From the perspective of someone researching monozukuri, I think the equipment is extremely well-equipped.

Under its "Fab Campus" concept, SFC has various digital fabrication facilities, Fab Labs, and even large-scale workshop facilities both on and off campus.

There's an environment where students who have learned how to use a 3D printer in class can easily make a prototype if they want to.

Inside the Tanaka Lab, there are 3D printers that can output larger sizes. Not only that, but there are also machines for cutting and shaping wood and metal, and laser cutters that can cut out various materials. I once used this laser cutter to make a prototype of pediatric IV drip securing tape cut into the shapes of animals and vehicles. The equipment is all there to let you move your hands and make things as soon as you get an idea.

Having an environment and atmosphere where you can immediately give form to an idea is something unique to SFC, I think. I really like the feeling that it's telling you, "Go ahead and do what you like."

Currently, in my seminar, students from multiple fields such as the Faculty of Nursing and Medical Care, the Faculty of Environment and Information Studies, and the Graduate School of Media and Governance come together, creating a very interesting environment. With students from different specializations gathering, nursing students and monozukuri students teach each other their areas of expertise and create things together. I think this is a rare format even within Keio.

I also think there's a lot of interaction with students from other labs. By communicating with students from other labs when we meet, I can get advice from a perspective different from my own research area and exchange opinions. I feel that this kind of atmosphere, where you can casually cross lab boundaries, is also unique to SFC.

I believe that entering graduate school after my experience as a nurse has been a significant plus for my research. By conveying my on-site experience and the atmosphere of the field to my seminar members during discussions, I often feel that it serves as a stimulus, leading to new monozukuri.

Also, I think it's a big advantage that, because I was a nurse, I can have the perspective of how to introduce the things I've made into the medical field.

To put it bluntly, if you proceed with a mindset of "I'm going to change medicine with technology!", the focus shifts too much toward the technology. If you try to solve problems with technology alone and create things while ignoring the operational realities of the medical field, it will actually increase the burden on the medical staff when it's introduced. It's a great advantage that I, with my nursing experience, can connect with various people on the ground and fine-tune that balance.

Currently, separate from the "Fab Nurse" project, I am engaged in an activity called "Digital Hospital Art" as a personal project. The appeal of "digital art" is its interactivity—when you perform an action like touching or moving, a reaction occurs and comes back as visuals or sound. This is an attempt to introduce that digital art into the medical field.

The first thing I worked on was for children with severe motor and intellectual disabilities, known as "children requiring medical care," who cannot live without medical assistance. For these children, who live in hospitals or at home with ventilators, even going outside is difficult, and some have spent almost their entire lives since birth inside a hospital.

For such a child, I created a digital art piece of a starry sky that reacts to their body movements. This child was bedridden and had almost never been outside, but when they moved their hand, a reaction would occur in the starry sky projected in their line of sight, with shooting stars flying by or constellations appearing.

During this, we had the child perform the same movements as in their usual rehabilitation, and the medical staff who assisted commented, "I felt their arm relax slightly when I was supporting them." I'm sure the child felt something too, and the medical staff were very pleased by it. They told me that being able to give the child a new experience while still in bed became a source of motivation for all the staff.

I also started receiving comments like, "I realized there are solutions like this," and suggestions like, "Couldn't we do this?" I strongly felt that we could explore ways to solve problems that are difficult to address with medicine alone by communicating together.

What I make a point of doing is assessing the patient as a nurse (*The process of collecting and analyzing patient information to identify issues that need to be resolved for them to lead an independent daily life), thinking about what the optimal future outcome would be, creating a care plan for that, and then adding technology to it.

You could call it "care-oriented" design. The goal is not to implement technology; rather, the focus is on aligning with the patient's care plan and making it better, and I am very careful about how design and engineering can be integrated into that.

In the "Fab Nurse" project as well, I always talk not only to the patients but also to the medical staff. By asking from a nurse's perspective what would be a good future for the patients and the medical field, I can set goals and advance monozukuri to achieve them.

As one of the projects that spun off from "Fab Nurse," I also conduct workshops that provide opportunities for people in the medical field to learn what 3D printers are and to try making something themselves.

The "Workshop to Make Toys for Children with Upper Limb Deficiencies" that we actually held was attended not only by nurses but also by various medical staff such as occupational therapists and physical therapists.

It was a two-day workshop. On the first day, participants learned the basics of modeling. On the second day, the children receiving care also participated, and we had the participants make toys tailored to each child.

What they made was a toy that shoots an arrow by pulling it back like a crossbow. Since the location of the children's limb deficiencies differed, we measured each child's body and had the participants create the necessary parts with a 3D printer. For example, a part to attach to the end of the arm for a child missing a forearm, or a part that attaches to one foot so a child with no arms can pull it with their other foot.

The program for this workshop was put together with the doctor in charge of rehabilitation and an occupational therapist. I was mainly in charge of teaching the basics of modeling, while the doctor and occupational therapist thought about what to actually make.

The key was to create a program that not only allows children with different physical conditions to play with the same toy but also helps solve their challenges. One of the challenges for children with arm deficiencies was "acquiring bimanual actions." They tend to move only their non-deficient hand, but by being able to use both hands, they can acquire actions like holding something down while moving or pulling something else. To achieve this, it's important to accumulate experiences where "using both hands is effective," so we incorporated that into the play.

The "Fab Nurse" project is now in its third year, and we have made considerable progress in terms of making things and putting them into practice. From now on, I'm thinking about how to involve people from other fields. How to realize the project while involving not only nurses but also various medical professionals and patients' families. I think that is the future challenge and also the fun part.

I also want to create initiatives and examples of implementation that involve people not just from the medical field but also from design and engineering. I believe that by working with people from other fields, we can create better solutions for problems that cannot be solved by medicine alone.

Until now, Japan has pursued the "standardization" of environments and treatment policies to provide a large amount of medical care as efficiently as possible. However, as the human resources available to provide that care become increasingly scarce, the current environment where everyone can routinely receive the same medical care will no longer be sustainable. That is why I believe it will be essential to involve people from other fields and improve the situation from a perspective that is not limited to medicine.

With "Digital Hospital Art" as well, I think the possibilities will expand by having people from various fields join in. We might be able to help patients with physical disabilities find new goals, thinking "I can do this," or even realize things like freely making music, dancing, or drawing with just the movement of their eyes.

I want to create such a "world where everyone can live freely" by improving the medical field.

To me, the Graduate School of Media and Governance is a place where I can conduct research freely.

Hiroya Tanaka Laboratory, Keio SFC

Hiroya Tanaka Lab

Keywords: Design Tools, Design Machines, Personal Fabrication, Social Fabrication

Research Content: We research the future evolution of digital fabrication technology from both technological development and social application perspectives. We are also dedicated to fostering a new type of engineer who can understand the essence of this technology and master its use.