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基層官僚視角下急診護理師裁量權運用研究:以桃園市公立醫療院所的案例分析;基層官僚視角下急診護理師裁量權運用研究:以桃園市公立醫療院所的案例分析

title: 基層官僚視角下急診護理師裁量權運用研究:以桃園市公立醫療院所的案例分析;基層官僚視角下急診護理師裁量權運用研究:以桃園市公立醫療院所的案例分析 abstract: 急診護理師位處醫療體系第一線，除臨床照護工作外，亦承擔健康政策執行與制度落實之重要角色。然而，急診場域長期面臨急診壅塞、病患滯留、護理人力不足及病情高度不確定等挑戰，使第一線人員經常必須在有限時間與資源條件下進行判斷與決策。在此情境下，裁量權不僅是臨床工作的實務需求，更是健康政策得以落實的重要機制。相較於社會福利、教育或警政等領域，國內關於醫療場域基層官僚裁量行為之研究仍相對有限，尤其缺乏對急診護理師政策執行經驗之深入探討。本研究以Lipsky （1980）基層官僚理論為主要分析架構，並結合Zacka（2017）有關技術裁量、規範裁量與道德能動性之觀點，探討急診護理師於健康政策執行過程中的裁量實踐。研究採質性研究方法，以桃園市某公立醫療院所急診部門為研究場域，透過深度訪談、現場觀察及文件分析蒐集資料，進行主題分析。研究結果顯示，急診護理師之裁量並非制度偏離或個人任意決定，而是在高度不確定與資源受限情境下所形成之常態性實務運作模式。受訪者普遍指出，面對病情快速變化與急迫處置需求時，護理師往往需依據專業知識、臨床經驗及現場資訊進行判斷，透過病情評估、檢傷分級、優先排序及資源調配等方式回應病人需求。與此同時，護理師亦須在病人安全、照護品質、制度規範及資源限制之間持續進行權衡與取捨。研究亦發現，健康政策於急診現場並非被動執行，而是在第一線工作者持續詮釋、調整與實踐的過程中逐步形成具體樣貌。理論上，本研究驗證基層官僚理論於急診醫療場域之解釋力，進一步指出急診護理師之裁量不僅涉及專業技術判斷，更包含價值選擇與倫理考量。研究結果顯示，健康政策之執行係透過第一線工作者之專業實踐被具體化與在地化。實務上，未來制度設計宜由單純強調控制與監督，轉向建構支持性裁量環境，透過明確授權、法制保障、組織支持及合理人力配置，讓第一線人員於兼顧病人安全與制度要求下發揮專業判斷，以提升政策執行效能及醫療體系韌性。;Emergency Department (ED) nurses serve on the front line of the healthcare system， playing a crucial role not only in providing clinical care but also in implementing health policies and organizational regulations. However， emergency care settings are consistently confronted with chronic challenges， including ED overcrowding， patient boarding， nursing workforce shortages， and high levels of clinical uncertainty. Under these circumstances， frontline healthcare professionals are frequently required to make judgments and decisions within severely compressed timeframes and under significant resource constraints. In this context， discretion is not merely a practical necessity in clinical practice but also a critical mechanism through which health policies are translated into practice. Compared with research in the fields of social welfare， education， and policing， studies examining discretionary behavior among street-level bureaucrats in healthcare settings remain relatively limited in Taiwan， particularly with respect to emergency department nurses′ experiences in health policy implementation. This study adopts Lipsky′s (1980) Street-Level Bureaucracy Theory as its primary analytical framework and draws on Zacka′s (2017) conceptualization of technical discretion， normative discretion， and moral agency to examine how emergency department nurses exercise discretion in implementing health policies. A qualitative research design was employed， with the emergency department of a public medical institution in Taoyuan City serving as the research site. Data were collected through in-depth interviews， field observations， and document analysis， and subsequently analyzed using thematic analysis. This study adopts Lipsky′s (1980) Street-Level Bureaucracy Theory as its primary analytical framework and draws on Zacka′s (2017) conceptualization of technical discretion， normative discretion， and moral agency to examine how emergency department nurses exercise discretion in implementing health policies. A qualitative research design was employed， with the emergency department of a public medical institution in Taoyuan City serving as the research site. Data were collected through in-depth interviews， field observations， and document analysis， and subsequently analyzed using thematic analysis. From a theoretical perspective， this study confirms the applicability of Street-Level Bureaucracy Theory to emergency healthcare settings and further demonstrates that nurses′ discretionary practices encompass not only professional and technical judgment but also value-based decision-making and ethical considerations. The findings suggest that health policy implementation is operationalized and contextualized through the professional practices of frontline healthcare workers. From a practical perspective， future institutional design should move beyond an exclusive emphasis on control and supervision toward the development of supportive environments that facilitate appropriate discretionary practice. Through clear authorization， legal protection， organizational support， and adequate staffing arrangements， frontline healthcare professionals can exercise sound professional judgment while maintaining both patient safety and compliance with institutional requirements， thereby enhancing the effectiveness of health policy implementation and strengthening the resilience of the healthcare system.

地方政府與民間基層組織協力治理之研究：以桃園市原住民族協進會為例;A Study of Collaborative Governance between Local Governments and Grassroots Organizations: The Cases of the Indigenous Affairs Promotion Association， Taoyuan City Taiwan

title: 地方政府與民間基層組織協力治理之研究：以桃園市原住民族協進會為例;A Study of Collaborative Governance between Local Governments and Grassroots Organizations: The Cases of the Indigenous Affairs Promotion Association， Taoyuan City Taiwan abstract: 隨著臺灣原住民族人口持續向都市遷移，都市原住民族已逐漸成為重要之政策與學術研究議題。桃園市為全國都會原住民族人口數最多之城市，長期透過各行政區辦理豐年祭儀，以促進文化傳承與族群認同，其運作仰賴民間基層組織桃園市原住民族協進會與政府機關協力合作共同推動。　　本研究採質性研究取徑，透過深度訪談法、參與觀察法、次級資料分析及文獻分析法蒐集資料，並以桃園市行政區豐年祭為研究場域，運用資源依賴理論，分析地方政府、區公所與民間基層組織之間的資源互賴關係及權力互動模式，以理解公私協力治理之運作機制。　　研究結果顯示，政府與民間基層組織之間呈現高度資源互賴關係。政府掌握財務、行政及制度性資源，而民間基層組織則具備文化祭儀專業知識、社群網絡動員能力及地方執行力，雙方透過資源交換共同推動豐年祭活動。雖然政府在經費配置、行政程序及制度規範上具有較強影響力，但民間基層組織憑藉文化權威與社群基礎展現其不可替代性，雙方在權力不對稱結構下仍維持平衡關係。此外，研究亦發現桃園市都市原住民族逐漸發展出兼具原鄉文化根源與都市生活經驗之都市原住民族文化，豐年祭已成為文化傳承、族群認同及社群凝聚的重要平台。　　桃園市原住民族協進會因其文化特殊性，具備民間基層組織之文化及社群連結能力，是超越傳統行政協助角色，為政府與族人之重要中介者，本研究建議地方政府持續強化與民間基層組織之夥伴關係，健全組織運作制度，並協助建立多元財源機制，以提升其自主性與永續發展能力，共同維繫都市原住民族文化治理之運作。;With the continuous migration of Indigenous peoples in Taiwan to urban areas， urban Indigenous peoples have increasingly become an important subject of both policy discussion and academic inquiry. Taoyuan City， which has the largest urban Indigenous population in Taiwan， has long promoted cultural transmission and ethnic identity through district-level Indigenous harvest festivals held across its administrative districts. The implementation of these festivals is facilitated through collaboration between the Taoyuan City Indigenous Affairs Promotion Association， a grassroots organization， and government agencies. This study adopts a qualitative research approach and employs in-depth interviews， participant observation， secondary data analysis， and document analysis to collect data. Using district-level Indigenous harvest festivals in Taoyuan City as the primary research setting， the study applies Resource Dependence Theory to examine the resource interdependence and power interaction patterns among local government， district offices， and grassroots organizations， thereby exploring the operational mechanisms of public–private partnership governance. The findings reveal a high degree of resource interdependence between government agencies and grassroots organizations. Government agencies possess financial， administrative， and institutional resources， whereas grassroots organizations provide expertise in cultural rituals， community mobilization capacity， and local implementation capabilities. Through resource exchange， both parties jointly facilitate the organization of district-level Indigenous harvest festivals. Although government agencies exercise greater influence through budget allocation， administrative procedures， and institutional regulations， grassroots organizations maintain their indispensability through cultural authority and strong community foundations. Consequently， despite the existence of an asymmetrical power structure， both parties are able to maintain a dynamic equilibrium. Furthermore， the study finds that urban Indigenous communities in Taoyuan City have gradually developed a form of “new urban-rural culture” that integrates Indigenous homeland cultural roots with urban life experiences. District-level Indigenous harvest festivals have become important platforms for cultural transmission， ethnic identity formation， and community cohesion. Owing to its distinctive cultural characteristics， the Taoyuan City Indigenous Affairs Promotion Association possesses strong capacities for cultural preservation and community engagement. Its role extends beyond that of a traditional administrative support organization and has evolved into a crucial intermediary between government agencies and Indigenous communities. Accordingly， this study recommends that local governments continue to strengthen partnerships with grassroots organizations， improve organizational governance mechanisms， and support the development of diversified funding sources in order to enhance organizational autonomy and long-term sustainability， thereby contributing to the continued operation of urban Indigenous cultural governance.

家事調解程序制度之研究—以未成年子女最佳利益之保障為核心;家事調解程序制度之研究—以未成年子女最佳利益之保障為核心

title: 家事調解程序制度之研究—以未成年子女最佳利益之保障為核心;家事調解程序制度之研究—以未成年子女最佳利益之保障為核心 abstract: 隨著現今社會價值觀之演變與離婚率之攀升，家事紛爭中所衍生之未成年子女親權酌定與利益保障問題日益複雜。傳統以法院訴訟解決糾紛之對抗式程序，往往曠日費時且具高度敵對性，不僅耗費司法資源，更對家庭和諧與子女之身心發展造成負面衝擊。為此，我國於家事事件法中引入「家事調解」此一替代性爭端解決機制，落實調解前置原則，期能透過中立第三方之協助，促進當事人自主溝通與合作，緩和對立情緒並降低法律程序之敵對性。然而，實務運作上仍面臨諸多困境與挑戰，例如當事人間之權力不對等、高度情緒張力及資訊不對稱等問題，往往使弱勢權益受到忽視。因此，如何於家事調解程序中具體落實「未成年子女最佳利益」原則，並適度保障兒童表意權，避免未成年子女淪為父母爭執之工具，實為當今家事法學與實務界亟待探究之核心課題。本研究以未成年子女最佳利益之保障為核心，深入探討我國家事調解制度之運作現況與潛在困境。研究方法兼採文獻分析法與深度訪談法，除系統性梳理國內外法制與學說文獻外，更邀請第一線之實務工作者（家事調解委員、家事律師）進行實證訪談。本文旨在剖析調解實務中如何建構「合作父母」之理念並協助其共同履行親職，藉此全面保障未成年子女於調解中之程序主體性與實體利益，進而對提升我國家事調解品質、精進實務運作及健全法制體系，提出具體且可行之建議。;With the evolution of contemporary social values and the rising divorce rate， issues regarding custody determination and the safeguarding of the interests of minor children arising from family disputes have become increasingly complex. Traditional adversarial procedures of court litigation for dispute resolution are often time-consuming， costly， and highly hostile. They not only consume substantial judicial resources but also exert a negative impact on family harmony and the physical and mental development of children. To address this， Taiwan′s Family Matters Act introduced "family mediation" as an Alternative Dispute Resolution (ADR) mechanism， implementing the principle of pre-litigation mediation. It aims to facilitate autonomous communication and cooperation between parties through the assistance of a neutral third party， thereby mitigating confrontational emotions and reducing the adversarial nature of legal proceedings. However， practical operations still face numerous dilemmas and challenges. Issues such as power imbalances between the parties， high emotional tension， and information asymmetry often lead to the neglect of the rights of the vulnerable. Therefore， how to concretely implement the principle of the "best interests of the child" within family mediation proceedings and properly safeguard the child′s right to be heard—thereby preventing minor children from being used as tools in parental disputes—has become a core issue urgently requiring exploration in contemporary family law scholarship and practice. Centering on the protection of the best interests of minor children， this study delves into the current operational status and underlying difficulties of Taiwan′s family mediation system. Adopting both literature analysis and in-depth interviews as its research methodologies， this study systematically reviews domestic and international legal frameworks and academic literature， and further conducts empirical interviews with frontline practitioners， including family mediators and family lawyers. This thesis aims to analyze how to deepen the concept of "cooperative parenting" in mediation practice and assist parents in jointly fulfilling their parental responsibilities. By doing so， it seeks to comprehensively safeguard the procedural autonomy and substantive interests of minor children during mediation. Ultimately， this study proposes concrete and feasible recommendations to enhance the quality of family mediation in Taiwan， refine practical operations， and perfect the legal system.

新冠疫情與履約責任之研究;COVID-19 Pandemic and the Liability for Performance of Contracts

title: 新冠疫情與履約責任之研究;COVID-19 Pandemic and the Liability for Performance of Contracts abstract: COVID-19疫情對契約履行造成全面性衝擊，凸顯現行契約法制在面對重大情事變動時之調整能力與制度界限。本文以租賃產業與公共工程產業為分析對象，檢視我國實務於疫情期間之履約責任運作模式，發現不同產業之契約類型在法律評價上呈現顯著差異：租賃關係多透過情事變更原則進行契約調整，公共工程則多透過不可抗力制度處理履約障礙，其調整重點集中於工期展延及違約責任之減免，而對於疫情造成之履約成本增加，則欠缺完整之法律調整機制，致使相同外在事件於不同契約類型下產生不同之風險分配結果。本文進一步指出，上述差異並非僅源於契約性質不同，而係現行法制採取不可抗力與情事變更之二元架構，使重大情事變動所引發之契約失衡問題，分別置於不同法律制度下處理，致法律評價欠缺一致性。透過比較德國民法第313條契約基礎障礙制度之理論與疫情期間之適用經驗，本文認為，以契約基礎重大變動為出發點，建立整合性審查思維，更能妥適回應重大公共危機下契約風險重新分配之需求。基此，本文主張，再面對重大公共危機情境下，我國契約法制宜借鏡德國民法第313條契約基礎障礙制度之理念，由現行「不可抗力」與「情事變更」之二元架構，逐步朝向以契約基礎重大變動為核心之審查模式發展，以提升法律適用之一致性與可預測性，並強化契約法因應未來重大公共危機及其他不確定風險之調整能力。;The COVID-19 pandemic has imposed a comprehensive impact on contract performance， highlighting the adjustment capabilities and institutional boundaries of the current contract law system when facing major changes of circumstances. Focusing on the leasing and public works industries， this thesis examines the operational models of performance liability in Taiwan′s judicial and administrative practice during the pandemic. The analysis reveals significant disparities in legal evaluation across different contract types: while leasing relationships frequently utilized the doctrine of change of circumstances for contractual adjustment， public works primarily relied on the force majeure mechanism to address performance barriers. In public works， adjustments were heavily concentrated on the extension of time (EOT) and the mitigation or exemption of default liability. However， a comprehensive legal mechanism remains lacking to address the increased performance costs caused by the pandemic， resulting in divergent risk allocation outcomes for identical external events under different contract types. This thesis further points out that such disparities stem not only from the distinct nature of the contracts， but also from the binary framework of force majeure and change of circumstances in the current legal system. This framework processes contract imbalances triggered by major crises under separate legal regimes， leading to a lack of consistency in legal evaluation. By conducting a comparative analysis of the doctrine of "interference with the basis of the transaction" under Section 313 of the German Civil Code (BGB) and its application during the pandemic， this thesis argues that establishing an integrated analytical framework based on the fundamental change in the basis of the contract can more appropriately address the need for contract risk reallocation during major public crises. Accordingly， this thesis proposes that when facing major public crises， Taiwan′s contract law system should draw inspiration from the concept of Section 313 of the German Civil Code. The current system should gradually transition from the binary framework of "force majeure" and "change of circumstances" toward an analytical model centered on major changes in the basis of the contract. This shift aims to enhance the consistency and predictability of legal application， thereby strengthening the adaptive capacity of contract law to respond to future public crises and other uncertain risks.