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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 羅昌發 | |
| dc.contributor.author | Yasushi Takahashi | en |
| dc.contributor.author | 高橋靖 | zh_TW |
| dc.date.accessioned | 2021-06-16T03:42:32Z | - |
| dc.date.available | 2015-03-13 | |
| dc.date.copyright | 2015-03-13 | |
| dc.date.issued | 2015 | |
| dc.date.submitted | 2015-02-12 | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/54953 | - |
| dc.description.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。 | zh_TW |
| dc.description.abstract | 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. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-16T03:42:32Z (GMT). No. of bitstreams: 1 ntu-104-D97a21011-1.pdf: 1962651 bytes, checksum: 9bcf7bcf074cb1929f5a0be6a698cabe (MD5) Previous issue date: 2015 | en |
| dc.description.tableofcontents | 1 INTRODUCTION 1
1.1 Objectives 1 1.2 Background 2 1.3 Methodology 3 1.4 Scope 4 1.5 Structure 5 1.6 Chapter Introduction 5 2 NURSING AND LAW 8 Introduction 8 2.1 Nursing 8 Introduction 8 2.1.1 Definitions 8 2.1.1.1 Definition of Nursing by the ICN 8 2.1.1.2 Definition of Nurse by the ICN 13 2.1.1.3 The ICN Code of Ethics for Nurses 15 2.1.1.4 Nursing Theories behind the ICN’s Definition of Nursing 16 2.1.1.5 Definitions of Nursing by National Nursing Associations 19 2.1.2 Historical Background of the Formation of Conventional Nursing 20 2.1.2.1 Present Nursing under the Past 20 2.1.2.2 Midwifery, Medicine and Nursing in the Nineteenth Century 21 2.1.2.3 Tamed “Female Lay Healing” and Invented Nursing 22 2.1.2.4 Introduction of the USA’s Nursing into Japan 24 2.1.3 Nursing Process and Interventions, and Legality 26 2.1.3.1 Nursing Process 26 2.1.3.2 Nursing Interventions and Legality 27 Conclusion 28 2.2 Law and Nursing 28 Introduction 28 2.2.1 Laws Related to Health Care in Japan 29 2.2.1.1 Classification of Healthcare-Related laws 30 2.2.1.2 Laws on Healthcare Professionals 31 2.2.1.3 Laws on Healthcare Supply System 34 2.2.1.4 Laws on Hygiene/Sanitation and Prevention 35 2.2.2 Legal Notions Related to Nursing Practice 35 2.2.2.1 Justifiable Act 35 2.2.2.2 Contract 36 2.2.2.3 Responsibility 37 2.2.2.4 Employers’ Liability 39 2.2.2.5 Information 39 Conclusion 41 Chapter Conclusion 41 3 NEW AUTONOMOUS NURSING PRACTICE AND INDEPENDENT NURSES 42 Introduction 42 3.1 “New” “Autonomous” Nursing “Practice” and “Independent” Nurses in the USA 42 Introduction 42 3.1.1 Newness/Innovation 44 3.1.2 Practice 46 3.1.3 Autonomy or Specialties 49 3.1.4 Independence or Titles 50 Conclusion 52 3.2 Needs and Expectations Leading to the Demand for Autonomous Nursing and Independent Nurses 52 Introduction 52 3.2.1 Needs and Expectations in Various Nursing Specialty Sectors in the USA 53 3.2.1.1 In Adult Health and/or Gerontological Nursing 53 3.2.1.2 In Ambulatory Care 55 3.2.1.3 In Hospice and Palliative Care 56 3.2.1.4 In Pediatric Nursing 57 3.2.1.5 In Perinatal Nursing 57 3.2.1.6 In Perioperative Nursing 58 3.2.1.7 Other Nursing Specialties 59 3.2.2 Governmental Needs and Expectations Concerning Cost 59 3.2.2.1 Cost, Sustainability and Healthcare Paradigms 59 3.2.2.2 Cost Containment 61 3.2.2.3 NPs and Cost Containment 63 Conclusion 64 3.3 Types of Nurses and AP(R)Ns in the World 64 Introduction 64 3.3.1 ICN’s Perspectives on APN 64 3.3.1.1 Characteristics of APN 65 3.3.1.2 Issues Concerning APN 66 3.3.2 Types of Nurses and Nursing Legislation in Some Jurisdictions 68 3.3.2.1 The USA 68 3.3.2.2 France 72 3.3.2.3 Germany 75 3.3.2.4 South Korea 75 3.3.2.5 Taiwan 77 3.3.2.6 The UK 78 Conclusion 79 Chapter Conclusion 79 4 ISSUES IN JAPAN’S HEALTHCARE DEMAND AND SUPPLY, AND THE MEASURES 80 Introduction 80 4.1 Characteristics of Japan’s Healthcare Demand Issues 80 Introduction 80 4.1.1 Overview of Health-Related Statistics 80 4.1.2 Consultation Modes and Ages 81 4.1.3 Uninsured and insecure citizens 81 4.1.4 Chronic Diseases 82 4.1.5 Moral Hazard in Emergency Rooms 83 Conclusion 83 4.2 Characteristics of the Healthcare Supply Issues 83 Introduction 83 4.2.1 Doctor Shortage 84 4.2.1.1 Career Path and Preference of Doctors 84 4.2.1.2 Uneven Distribution in Geographical Areas 86 4.2.1.3 Uneven Distribution in Medical Fields 86 4.2.1.4 Increase of Female Doctors 87 4.2.1.5 Sub-Specialties 88 4.2.1.6 Increase of Workload 88 4.2.1.7 Ageing Doctors 89 4.2.1.8 Priority of Research in Organs/Parts and Specialties 90 4.2.2 Free Access to Medical Services 90 4.2.3 Fee-for-Service Payment and the “Cost” Issue 91 4.2.4 Freedom and Equality 93 4.2.5 Inappropriate Use of Medical Intervention 94 4.2.6 Lack of Prevention 96 4.2.7 Free Health Care for the Elderly (in the Past) 97 4.2.8 Hospital as Nursing Home or Social Hospitalization 98 4.2.9 More than One Doctor for One Patient 99 4.2.10 Nurses Working for Private Institutions 100 4.2.11 Medical Dominance 100 Conclusion 101 4.3 Measures for the Solution of the Issues 101 Introduction 101 4.3.1 Measures at a Central Government Level 101 4.3.2 Measures at a Local Government Level 102 4.3.3 Measures by Doctors and Medical Associations 104 4.3.4 Proposals by Researchers 106 Conclusion 108 4.4 Nursing Reforms for the Solution of the Issues 108 Introduction 108 4.4.1 Efforts by the Executive Branch 109 4.4.1.1 Efforts by the Executive Branch Through Ordinances and Notices 109 4.4.1.1.1 Education 109 4.4.1.1.2 Scope of Practice 111 4.4.1.2 Reform Efforts by the Executive Branch Through an Investigative Commission 114 4.4.2 Reform Efforts by the JNA and Its Associates 116 4.4.2.1 Credentialing Systems 116 4.4.2.2 Significance of the Credentialing Systems for the Proposal 118 4.4.3 Reform Efforts by the MHLW Resulting in the 2014 Bill 119 4.4.3.1 Discussions before Nursing Reform Bill Drafting --- “Vision Report” 119 4.4.3.2 Discussions before Nursing Reform Bill Drafting --- “Team Care Report” 122 4.4.3.3 Discussions for Nursing Reform Bill Drafting 125 Conclusion 129 Chapter Conclusion 129 5 NURSES AS KEY PERSONNEL IN JAPAN’S CONTEMPORARY HEALTHCARE SITUATIONS 131 Introduction 131 5.1 Nurse-Led Health Care 132 Introduction 132 5.1.1 Reality of Nurse-Led Health Care 132 5.1.1.1 Home Visit/Visiting Nurse/Nursing 133 5.1.1.2 Occupational Health Nurse/Nursing 137 5.1.1.3 School Nurse/Nursing 138 5.1.2 Possibility of Various Healthcare Professions as a Healthcare Basis 139 Conclusion 141 5.2 Obstacles Against Nurses as Key Personnel --- Situations Seen from Sociological Perspectives 142 Introduction 142 5.2.1 Obstacles 143 5.2.1.1 Obstacles Arising from National, Political Histories of Medicine 143 5.2.1.2 Obstacles Arising from Schooling and Exam 144 5.2.1.3 Obstacles Arising from Schooling in “Esoteric Knowledge” of Medicine 144 5.2.1.4 Obstacles Arising from Nursing Education at Medical Facilities 145 5.2.1.5 Obstacles Arising from Nurses’ Job Duties in Japan 146 5.2.2 Nurses’ Challenge Against the Obstacles 148 Conclusion 151 5.3 Inappropriateness of Medicine-Based Health Care 151 Introduction 151 5.3.1 The Biomedical Model and Acute and Chronic Diseases 152 5.3.2 The Biomedical Model and its Five Assumtions 153 5.3.2.1 The Biomedical Model 153 5.3.2.2 Five Assumptions 155 5.3.3 The Biomedical Model and Issues 158 5.3.3.1 Subjectivity or Arbitrariness 159 5.3.3.2 Chronic Diseases and Technologies of the Biomedical Model 161 5.3.3.3 Technology Out of Control 162 5.3.3.4 Inertia of the Biomedical Model 163 Conclusion 164 5.4 Communication 164 Introduction 164 5.4.1 Doctor-Patient Relationship in Communication Models 166 5.4.2 Communication Models in Medicine, and Issues 168 5.4.2.1 Theory and Practice 168 5.4.2.2 Rationing of Time 169 5.4.2.3 Uncertainty 170 5.4.2.4 Contingency of Communication Between Patients and Other Healthcare Professionals 171 5.4.2.5 Consent and Differences in Objectives 172 5.4.2.6 Other Relationship-Related issues 173 5.4.3 Nurse-Patient Relationship in Nursing Theories and Practice 174 5.4.3.1 Relationship as the Central Feature of Nursing Practice 174 5.4.3.2 Communication in Nursing 175 Conclusion 176 5.5 Desirability of Independent Nurses for Contemporary Health Care in Japan 176 Chapter Conclusion 177 6 A PROPOSAL 178 Introduction 178 6.1 Proposal and the Elements 178 6.1.1 Local Governments 178 6.1.2 Post 179 6.1.3 Limitation in Number 181 6.1.4 Health Care Designed for Communities’ Specific Needs 182 6.1.5 Independence 183 6.1.6 Public Officer 185 6.1.7 Regional Restriction 186 6.2 Issues 187 Introduction 187 6.2.1 Issues in Relation to Qualification 187 6.2.1.1 Qualification and Quality Assurance 187 6.2.1.2 Licensure, Accreditation, Certification and Education 187 6.2.1.3 Requirements for Nurses at the Post 189 6.2.1.4 Education Requirements Determined by Local Authorities 191 6.2.1.5 Scope of Practice 192 6.2.1.6 Quality Assurance 193 6.2.2 Issues in Relation to Laws and Policies 193 6.2.2.1 “Legal” Reform 193 6.2.2.2 Determination of Additional Functions 194 6.2.2.3 Size of a Region 195 6.2.2.4 Free Access to Medicine 196 6.2.2.5 “Mini Doctor” 196 6.2.2.6 Prescriptive Authority 197 6.2.2.7 Duty of Care 200 6.2.3 Issues in Relation to Advantages and Benefits 201 6.2.3.1 Advantages of Post System 201 6.2.3.2 Benefits in Terms of Three Healthcare Values 202 6.2.4 Issues in Relation to Nursing and Nursing Circles 202 6.2.4.1 Influence on Nurses and Nursing 202 6.2.4.2 Relationships among Various Nursing-Related Title Holders 204 6.2.4.3 Competency to Practice Independently 204 6.2.4.4 Preference Regarding Authorization 205 6.2.4.5 Willingness to Be a Nurse at the Post 205 6.2.5 Issues in Relation to Medicine and Medical Circles 206 6.2.6 Issues in Relation to the Applicability of the Proposal to Other Jurisdictions 208 7 CONCLUSIONS 210 | |
| dc.language.iso | en | |
| dc.subject | 實務範圍 | zh_TW |
| dc.subject | 護理師 | zh_TW |
| dc.subject | 法規 | zh_TW |
| dc.subject | 生物醫學模式 | zh_TW |
| dc.subject | 獨立 | zh_TW |
| dc.subject | 放寬管制 | zh_TW |
| dc.subject | 日本 | zh_TW |
| dc.subject | deregulation | en |
| dc.subject | scope of practice | en |
| dc.subject | nurse | en |
| dc.subject | law | en |
| dc.subject | Japan | en |
| dc.subject | independence | en |
| dc.subject | biomedical model | en |
| dc.title | 日本引進獨立護理師執業制度之修法研議 | zh_TW |
| dc.title | Legal Reform Proposal for Independent Nurses’ Practice in Japan | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 103-1 | |
| dc.description.degree | 博士 | |
| dc.contributor.oralexamcommittee | 張媚,陳聰富,林彩瑜,楊培侃 | |
| dc.subject.keyword | 生物醫學模式,放寬管制,獨立,日本,法規,護理師,實務範圍, | zh_TW |
| dc.subject.keyword | biomedical model,deregulation,independence,Japan,law,nurse,scope of practice, | en |
| dc.relation.page | 231 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2015-02-12 | |
| dc.contributor.author-college | 法律學院 | zh_TW |
| dc.contributor.author-dept | 法律學研究所 | zh_TW |
| 顯示於系所單位： | 法律學系 | |
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