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第6階段 — 評估結果。檢視班次趨勢並選擇最佳的評估和交班計畫。改善不代表個案A的肺栓塞或個案D的譫妄風險已解決。

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Time	Data
0700 handoff	A: sudden dyspnea, SpO2 89 percent RA, HR 110, RR 24, BP 138/86, new unilateral calf findings. D: oriented to person and place instead of documented baseline times three, unsafe bed-exit attempts.A：突發性呼吸困難，室內空氣SpO2 89%，心率110，呼吸頻率24，血壓138/86，新出現單側小腿發現。D：僅能辨識人與地點，而非記錄的基準三次，有不安全的下床嘗試。
0715 coordinated response	RN stays with A, stops ambulation, applies prescribed oxygen, starts continuous monitoring, and activates provider and urgent-response pathways. UAP provides immediate safety presence for D once directed.註冊護理師留在個案A身邊，停止活動，給予醫囑氧氣，開始持續監測，並啟動醫護人員和緊急應變途徑。一旦指示，輔助醫護人員立即為個案D提供安全陪伴。
1000 after workup	A: CT confirms acute PE with mild RV strain; BP 130/80, HR 92, SpO2 95 percent on 2 L/min; therapeutic anticoagulation initiated after bleeding assessment. D: acute confusion reported and evaluated; no fall.A：電腦斷層確認急性肺栓塞伴輕度右心室負荷；血壓130/80，心率92，2公升/分鐘氧氣下SpO2 95%；出血評估後開始治療性抗凝血。D：報告並評估急性意識混亂；無跌倒。
1500 outcomes	A: monitored-unit transfer, BP 128/78, HR 88, SpO2 95 percent on 2 L/min, no bleeding. B: medication and teaching reinforcement completed and RN-evaluated. C: pain 3/10 and I&O completed. D: no fall or line removal; delirium assessment continues.A：轉入監測病房，血壓128/78，心率88，2公升/分鐘氧氣下SpO2 95%，無出血。B：藥物和衛教加強已完成並經註冊護理師評估。C：疼痛3/10，輸入輸出量已完成。D：無跌倒或管路移除；譫妄評估持續進行。

Q1. How should the RN evaluate the priority and delegation strategy?註冊護理師應如何評估優先順序和委託照護策略？

Effective initial management with improved physiology and completed stable-client care, but PE and delirium risks still require follow-up有效的初步處置，生理狀況改善且穩定個案照護已完成，但肺栓塞和譫妄風險仍需追蹤 Completely successful because all active diagnoses and safety risks resolved before handoff完全成功，因為所有現有診斷和安全風險在交班前已解決 Ineffective because any use of delegation during a critical event abandons the unstable client無效，因為在危急事件中使用委託照護會放棄不穩定個案

Q2. What information has the highest priority in handoff?交班時哪些資訊具有最高優先順序？

Patient A's confirmed PE, oxygen and anticoagulation plan, bleeding and deterioration triggers, plus Patient D's acute cognitive change and safety follow-up個案A確診的肺栓塞、氧氣和抗凝血計畫、出血和惡化觸發因素，以及個案D的急性認知改變和安全追蹤 Only Patient B's completed discharge paperwork because scheduled tasks define shift success僅個案B已完成的出院文件，因為排定的任務定義了班次成功與否 A request that the oncoming RN repeat every assessment without receiving current findings要求接班註冊護理師重複所有評估，而不接收目前的發現 Only the fact that no falls occurred, because current cognitive status no longer needs evaluation僅是沒有跌倒的事實，因為目前的認知狀態不再需要評估

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