護理業務與法律風險管理──以注意義務為中心

Legal Risk Management in Nursing Practice: The Importance of Duty of Care

在風險社會的現今，護理業務充滿著各種風險挑戰，糾紛與訴訟日漸增加，一旦護理人員成為被告，漫長的訴訟流程與壓力將造成巨大衝擊。近十年實務上嚴重度與頻率較高的護理糾紛包括：（一）未依標準作業流程操作、（二）敏感度不足，疏於照護、（三）未即時適切溝通與處理、（四）逾越護理法定業務範圍、（五）不實登載護理紀錄與作證。由這些嚴重度與可能性較高的法律風險，歸納出四大護理業務的重要注意義務。據此排定風險管理的優先順序，設定以實證為導向之護理常規標準，進行系統性的分析與管理。再者，強化護理工作中的法律意識培育，讓護理實務中的護理人員、所屬主管及機構清楚了解業務相關的民刑與行政責任三類法律責任。正視護理疏失恐造成的民事賠償責任、刑事過失傷害及過失致死之處罰、行政懲處等法律風險與不利後果，期能防患於未然，以減少訴訟與損失。

The steady and continued rise in medical-related disputes and lawsuits is one indicator of the myriad risks and challenges faced in today's nursing practice. When nurses become defendants, the lengthy litigation process and pressures that ensue greatly impact their professional and personal lives. Nursing practice dispute categories marked by particularly high severity and frequency over the past ten years include: (1) Failure to operate according to standard procedures, (2) Insufficient nursing sensitivity and negligent care, (3) Failure to communicate and deal with issues promptly and appropriately, (4) Beyond the scope of nursing practice, and (5) Falsification or alteration of nursing records. In this paper, the important duties of care in four major nursing practices are first summarized based on the relevant legal risks. Next, based on this, risk management procedures are prioritized, evidence-oriented nursing routine standards are set, and systematic analysis and management are conducted. In addition, to strengthen the legal awareness of nurses, nursing staffs, supervisors, and institutions must all understand clearly the three types of civil and criminal legal liabilities and their respective administrative responsibilities. Nurses should proactively work to handle the related legal risks and avoid the unpleasant consequences of civil liability in the realms of compensation, criminal punishment for negligent injury and homicide, and administrative disciplinary action.