專科護理師更換氣管外管之適法性－兼論執業範圍新規定

關於專科護理師（下稱專師）之執業範圍，民國96年前，無任何法令規範之，直至民國96年，衛生福利部始以行政函釋說明專師可執行醫療輔助行為、解釋病情、開立檢驗單、檢查單與領藥單、書寫病程紀錄單。專師之執業範圍若無明確規定，其執業範圍可能陷入模糊不清之窘境，專師執行業務，極易觸犯醫師法第28條規定之密醫罪。曾有專師於民國94年為病人更換氣管外管，遭檢察官起訴密醫罪，本文將介紹此案例－氣管外管案－之原因事實與法院判決理由，並對此案例進行分析，一則凸顯執業範圍未明確規定，專師極易觸犯密醫罪之現象；二則希望藉由具體案例，協助專師瞭解密醫罪之內涵。民國105年1月1日起，專師之執業範圍告別了以行政函釋規範之舊年代，正式進入以法律規範之新時代，護理人員法第24條第3項與第4項規定以及「專科護理師於醫師監督下執業辦法」所規範之專師執業範圍，因其清楚明確，對密醫罪之防堵，有一定程度之功勞，本文將一併介紹之。

關鍵字

專科護理師；執業範圍；醫療業務；醫療輔助行為；護理人員法

並列摘要

The law to regulate the scope of practice of a nurse practitioner(NP) is absent until 2007, and the Ministry of Health and Welfare interprets the legal implantation for a NP may include medical assistance, condition-explaining, examination bill and lab bill and prescription bill ordering, progress notes writing by the interpretative rules after 2007. It would easily against the Article 28 of the Physician Act to let a NP to be prosecuted for a physician without license, because the scope of implemented practice of a NP was indefinite and illegalization. One nurse practitioner who changed the outer cannula of tracheostomy tube for a patient was prosecuted for physician without license in 2005. This study introduces and analysis this case in order to emphasize the indefiniteness of the scope of practice of a NP easily results in the infraction for a NP, and to help the NPs understand the connotation of the Article mentioned above. A NP is able to free to be charged with being a physician without license since January 1, 2016, because the regulations from the Paragraph 3 and Paragraph 4 of Article 24 of the Nursing Personnel Act and the Guidelines on Implementation of Medical Practices for Nurse Practitioners under Supervision of Physicians were amended to define clearly the scope of NP. This study deeply discusses the influence and consequence from the regulations as well.

並列關鍵字

Nurse Practitioners ； Scope of Practice ； Medical Practices ； Assisting Medical Practices ； Nursing Personnel Act

參考文獻

葉淑惠、邱慧洳、林麗味（2015）．精神科專科護理師執業範圍的展望．長庚護理雜誌，26（4），410－424。[Yeh, S. H., Chiu, H. J., & Lin, L. W. (2015). The prospects of scope of practice among psychiatric nurse practitioners. Chang Gung Nursing, 26(4), 410-424.] doi:10.3966/102673012015122604004

蔡秀鸞（2014）．世紀回眸－臺灣護理專業的角色拓展．護理雜誌，61（4，附冊），69－77。[Tsay, S. L. (2014). Centennial retrospective on the role expansion of the nurs ing profession in Taiwan. The Journal of Nursing, 61(4, Suppl.), 69-77.] doi: 10.6224/JN.61.4S.69

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專科護理師更換氣管外管之適法性－兼論執業範圍新規定

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