專科護理師之預立特定醫療流程的發展與範例

「專科護理師」於2000年立法正名後，開始有執業的法源依據，但工作內容與角色定位仍常有界定不清與缺乏共識的情形，特別是針對輔助醫師執行醫療業務的部分僅能以護理人員法第24條護理人員之業務中的「醫療輔助行為」予以解釋，常使專科護理師在執行醫療業的適法性上有所爭議。在醫護共同努力下，於2014年8月立法院臨時會期通過護理人員法第24條條文修正，擴充專科護理師之業務，除原護理師的法定業務外，增列專科護理師與接受專科護理師訓練期間之護理師，得於醫師監督下執行醫療業務。衛福部因應此項條文之修訂以及確保專師執行醫療行為之品質與安全性，於2015年10月公告「專科護理師於醫師監督下執行醫療業務辦法」，規範專師於醫師監督下得執行之醫療業務內涵以及監督之定義及方式，同時明定得由醫師預立醫療流程及相關規定。自此專科護理師執行醫療業務有了更具體的法源依據，工作內容與執業範圍也更為明確。然而，預立醫療流程的發展與訂定並無過去經驗可以參照，為縮短摸索期與凝聚共識，特以本文分享發展預立特定醫療流程的經驗，主要內容包括臺灣專科護理師執業範圍的發展、專科護理師於醫師監督下得執行之醫療業務、預立特定醫療流程之精神與內涵、制訂時應注意事項與挑戰、及其對專科護理師執業的保障與衝擊，同時也提供三個範例作為後續發展之參考。

關鍵字

專科護理師；預立醫療流程；於醫師監督下執行醫療業務

並列摘要

In Taiwan, nurse practitioners are entitled to practice medicine legally since the Nurse Act amended in 2000. However, their scopes of practice and role functions were often indefinite and lack of consensus. The legality for nurse practitioners to carry out medical practices was controversial and only weakly covered by the regulation of ＂Medical Auxiliary Behaviors＂ described in the Article 24 of Nursing Personnel Act. Legislative Yuan, the Congress in Republic of China, amended Article 24 of Nursing Personnel Act in August 2014 to augment the practice scope of nurse practitioners. In addition to the practice scope of a registered nurse, a nurse practitioner or a nurse practitioner trainee also has the legal right to perform main medical practices under a physician's supervision. In response to the amendment and to ensure the quality and safety of nurse practitioners' medical practices, the Ministry of Health and Welfare promulgated ＂Regulation Governing Nurse Practitioners Carrying out Medical Practices under the Supervision of a Physician＂ in October 2015. This regulation specifies the nature of medical practices which can be performed by a nurse practitioner under the supervision of a physician, the definition and way of physician supervision, and the pre-established specific medical processes by a physician. Nurse practitioners in Taiwan can now perform main medical practices legally and their scopes of practice and job descriptions are more definite. Nevertheless, there is no previous experience or related reference for developing or drafting a physician pre-established specific medical processes. To shorten the exploration period and to develop consensus, we share our experience in developing the pre-established specific medical processes. The main contents of the article include the development of Taiwan nurse practitioners' scopes, medical practices which can be performed by a nurse practitioner under the supervision of a physician, the theoretical background, challenges and keys in drafting of the pre-established specific medical processes, and their impacts on and protections for nurse practitioners. We also provide three examples of pre-established specific medical processes for the readers' reference.

並列關鍵字

Nurse Practitioner ； Pre-established Medical Process ； Medical Practice under the Supervision of a Physician

參考文獻

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專科護理師之預立特定醫療流程的發展與範例

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