日本引進獨立護理師執業制度之修法研議

Abstract

日本面臨健康照護相關議題，如：慢性疾病的盛行與民眾健康照護需求的改變。然而，健康照護並未追趕上變化，而且健康照護這個領域仍為生物醫學模式所主導。 本論文之建議在於：護理要補充醫學體系，法律應該授予護理師業務上的獨立，以便採取特定的醫療介入(包含預防性措施)：(1)當醫療院所沒有(充足的)醫師，與(2)當病患未獲得妥當醫療介入。關於第(1)種情形，日本的護理師限於法規，在沒有醫師的指示之下無法執行醫療行為；第(2)種情形則是缺乏獨立，她/他們別無選擇地只能遵從醫師的指示，即使該指示並未顧及到病患的健康權益 (除非有明顯錯誤)。因此，在日本，醫學遠遠凌駕於護理之上。為了放寬護理師與護理工作的限制，本論文對於護理師規範提出分權策略的提案，因而需要修正(或修訂)護理師的國家法規：本提案目的是要以立法放寬護理業務的管制，提案如下：『日本的中央政府必須修正針對護理師的法規，以便可以讓地方政府開放特定職位給限定數量的護理師，以便於護理師可以獨立地提供針對社區需求提供之相對應的健康照護，就像地方公家機關主管們能在其指定區域中執行業務』。 本論文的方法或屬性為(此提案)質性研究。 本論文介紹護理與法規、檢視各種護理業務範圍、研究不同司法管轄區的護理法規、顯現日本現今健康照護的相關議題、評估現有針對這些議題的改革成效、強調護理師的重要性、指出前述的提案、以及討論本提案的預期結果與問題。

Japan is faced with such healthcare-related issues as chronic disease prevalence, and the citizens’ healthcare needs have been changing. Nevertheless, the healthcare supply systems have not caught up with the change, and the field of health care is still dominated by the biomedical model. This dissertation proposes that the doctor/medicine-based healthcare paradigm be supplemented by a nurse/nursing-based system and that, for the supplementation, independence be granted to some nurses so that they could initiate certain healthcare interventions inclusive of preventive measures 1) in the settings where there are not (enough) doctors and 2) for the patients for whom medical interventions are not appropriate. Regarding “1,” in principle, nurses in Japan cannot lawfully initiate (medical) interventions without doctors’ directions. And, regarding “2,” without independence, they have no choice but to follow doctors’ directions even if the directions are not for the benefit of the patients (unless they are obviously wrong). Thus, medicine’s reins on nursing are tight in Japan. In order to release nurses and nursing, this dissertation presents a proposal with such tactics as decentralization of the regulation on nurses and, therefore, demands an amendment to (or revision of) the national statute on nurses: the objective of the proposal is legislative deregulation of nurses’ practice. The proposal itself is as follows: “Japan’s central government should amend the statute on nurses so that it could allow the local governments to open special posts for a limited number of nurses and to have the nurses independently offer health care designed for the communities’ specific needs as local public officers who can do so only within their appointed regions.” The method or nature of this dissertation is qualitative research (for the proposal). The dissertation introduces nursing and law, examines the scopes of practice for nurses of various types, studies the statutes on nurses in some jurisdictions, shows the contemporary healthcare-related issues in Japan, criticizes the existing reform efforts for the solution of those issues, stresses the importance of nurses for the solution, makes the aforementioned proposal, and discusses the outcomes and issues expected of the proposal.