運用個案研究探討專科護理師照護疏失之原因

Reasons of Care Negligence on Nurse Practitioner:A Case Study

黃惠滿(Hui-Man Huang) ； 林妍君(Yen-Chun Lin) ； 周傳姜(Chuan-Chiang Chou)

《高雄護理雜誌》 33卷2期 (2016/08) Pp. 13-25

https://doi.org/10.6692/KJN-2016-33-2-2

摘要

台灣專科護理師屬於醫療機構編制的進階護理師，在醫院內頻繁執行醫療輔助行為，因照護疏失被起訴的機率也隨之增加。本研究採個案研究法，解析台北地方法院98年度醫訴字第6號刑事判決，歸納出案例中專科護理師發生照護疏失的原因及特徵類別，結果呈現照護疏失的導因有九特徵，分屬三主題：一、前置因子：醫院醫師夜間值班制度未完善、團隊成員間缺乏有效溝通或工作授權的機制；二、臨床判斷過程疏失：未妥善評估病人照護需求、未及時提供適當照護、未有效追蹤評值處置後病情變化；三、專科護理師的內部程序不完善：決策優先順序不正確、內在價值觀和信念不正確、出現未確實記載口頭醫囑的不良習慣、未遵循法律規範。建議藉由增進臨床判斷能力以減少專科護理師發生照護疏失的機會。

關鍵字

照護疏失 ； 專科護理師 ； 臨床判斷 ； 個案研究

並列摘要

Criminal prosecution of healthcare providers for care negligence is not unique to Taiwan jurisprudence. Nurse practitioners (NPs) are recruited by hospitals and are mainly educated through hospital training programmes. In clinical settings, the NP delivers more auxiliary medical behaviors than other nursing staff. The NPs are more likely to have a high incidence of care negligence litigation than other nursing staff. The purpose of this study is to identify the attributes and causes related to problems that have contributed to care negligence of the defendant NP. A case study was used to analyze a sentence of Criminal Judgment Yi-Su-Zi No.6 (2009) by the Taipei District Court in Taiwan. The study case represents a violation of Criminal Law Article 276-2. The defendant NP received a jail sentence of 3 months, which was suspended for 2 years. This study identified nine attributes on causality of care negligence, which were further categorized into three major themes, namely: the antecedent (insufficient on-duty doctors in hospital, lack of effective communication or authorization mechanism in hospital); failure to appropriately perform clinical judgment(failed to assess patient care needs, failed to conduct appropriate interventions, failed to appropriately evaluate the patient); and exhibition of inappropriate internal characteristics of the NP (ineffective priority decision-making, inappropriate internal attitudes and values, inappropriate habits on making notes, and not abiding by the law). In order to reduce further happenstance of care negligence, appropriate job training to improve clinical judgement capability for NPs is recommended.

並列關鍵字

care negligence ； nurse practitioner ； clinical judgments ； case study