目前在台灣，專科護理師參與醫療處置過程的一部分已經是一個必然的趨勢。雖然目前已針對專科護理師相關的法規做了修正，但是在實務上還是有許多需要克服的問題。修法後雖然對專科護理師的執業範圍包含非侵入性和侵入性醫療行為有了較明確的規範，專科護理師臨床執業面臨的困境還是存在。出現醫療爭議時，醫師、專科護理師、其他醫事人員及醫院的法律責任仍然有許多模糊地帶。專科護理師相關法規修法後，衛生局及醫療機構之因應準備仍有改善的空間。
本研究採用案例分析法依照案例事實、法院見解和爭點問題，討論一個發生在民國95年12月有關專科護理師與醫師的醫療爭議訴訟案件。本醫療糾紛個案是台灣專科護理師正式甄審後，發生的第一件專科護理師被起訴的醫療糾紛案件。
被告因業務過失致死案件，經檢察官提起公訴判決主文如下：主治醫師從事業務之人，因業務上之過失致人於死，處有期徒刑壹年，減為有期徒刑陸月，緩刑貳年。專科護理師從事業務之人，因業務上之過失致人於死，處有期徒刑陸月，減為有期徒刑參月，緩刑貳年。本案例經由臺灣臺北地方法院刑事判決98年度醫訴字第6號，臺灣高等法院刑事判決民國100年度醫上訴字第7號，目前檢察官上訴中。
台灣專科護理師法規未來修正的方向，需更進一步明訂專科護理師的執業範圍以符合法律明確性原則。醫師指示合法化，使醫療輔助行為之定義更明確。建立專科護理師專業能力標準與提升及評估專科護理師執業品質，加強專科護理師的訓練以及訂立專科護理師訓練醫院更完善的認證標準與訓練醫院評鑑制度。有關衛生福利部最近要制定的醫師助理法，其工作範圍與專科護理師有很多重疊之處，引進醫師助理可能造成的衝擊。制定合理的專科護理師的護病比，明定專科護理師是否可以值班?專科護理師是否可以採輪班，以符合勞基法一例一休的規定。我們仍然有很多可以改善的地方，希望有更明確的法律規範，讓合格的專科護理師加入醫療團隊的運作，提高專科護理師的專業能力藉以提升醫療服務品質。不要讓專科護理師面臨或甚至觸法的危險，最終有可能變成密醫，對於台灣的醫療會有很大的衝擊及影響。 / The participation of nurse practitioners in medical practice is a must in Taiwan now. Although amendment of law about the clinical practice for nurse practitioners was made, there are still some issues which should be further evaluated. The scope of medical practice for nurse practitioners includes invasive and non-invasive medical procedures, which were defined more clearly in the revised articles, but some ambiguous situations still persist. The juridical responsibility of doctors and nurse practitioners for medical disputes remains unclear. There is lots of space of improvement which bureau of Health and hospitals can do after the revision of related law for nurse practitioners.
The method of this research is a case study including case facts, the decision of the court and the issue of disputes. This is a medical dispute regarding doctors and a nurse practitioner, which occurred in December, 2006.This is the first medical dispute happening in Taiwan after the establishment of official examination for nurse practitioners.
The defendants were accused for guilty because of causing death of a patient due to professional negligence. The verdict of the superior criminal court in Taiwan in 2011 after public prosecution was as follows. The attending physician was sentenced for one year, reduced to six months and probated for 2 years because of causing death of a patient due to professional negligence. The nurse practitioner was sentenced for six months, reduced to three months and probated for 2 years because of causing death of a patient due to professional negligence.
The future amendment for the law regarding nurse practitioners is as follows: first, to enact the specific scope of medical practice for nurse practitioners according to the law; second, to legalize the directions from doctors; third, to specify the definition of assisted medical practice performed by nurse practitioners; fourth, to establish the standard for evaluating the ability of nurse practitioners; fifth, to elevate and evaluate the quality of medical service from nurse practitioners; sixth, how to strengthen the training programs of nurse practitioners, to build the verification standard of hospitals which can train nurse practitioners and improve the system of accreditation; seventh, to create rational ratio of nurse practitioners to patients; eighth, to clarify whether nurse practitioners can be on duty and in shifts in the hospital according to the law. In addition, the impact for nurse practitioners by introducing physician assistant to medical service suggested by Bureau of Health is high because there is lots of overlap of medical practice between the two professionals. We hope that the participation of verified nurse practitioners under the regulation of specific law can improve the quality of medical service, otherwise, we are afraid that nurse practitioners may break the law, become fake doctors and be sentenced, which will cause great impact and bad influence of medical service in Taiwan.
| Identifer | oai:union.ndltd.org:CHENGCHI/G0102961005 |
| Creators | 陳修聖, Chen, Shiou-Sheng |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
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