ISPN考試將近，添翼國際護士培訓學校公眾號特出考前特輯系列幫助大家解決ISPN考試常見問題。管理和委任類型題---Management and Delegation。
NCLEX®系列考試中有很多管理和委任類的題目，讓新手護士或護校生非常為難，我們都是菜鳥怎麼懂得如何管理和委派別人工作呢?有一點必須記住，護士不是孤膽英雄，護理工作也不能像好萊塢的電影宣傳個人英雄主義，我們需要龐大的團隊協作才能維護患者的健康和生命。作為團隊中的一份子，必須要了解管理、委派、監督和優先行動的基本的原則，否則會影響病人的安全。
ISPN考前特輯系列之三：解決管理和委任類題目
一、委任的原則
總結下來，很像一句繞口令---合適的狀況下，把合適的任務交給合適的人去做，並且確保這個行動是正確的，能夠在正確的監管之下完成。
二、具體分析委任
1、當你需要把一個任務委派下去的時候，要慎重考慮這個任務是否為常規護理的一部分?需不需要做護理診斷和評估?是否存在威脅患者安全的隱患?患者狀況是否穩定，結果是不是都在自己的預料之中?這個任務是不是有醫院規定的標準化程序做依據?任務的複雜性是否與被委派者的能力、熟練程度和專業程度相匹配?整個過程是不是能夠有效的監管和及時的跟進等等。
2、由於美國護士是分級制，你一定要充分了解不同級別的護士的執業範圍。
For RNs only：
Performing head-to-toe assessment including complex and/or routine vital signs.
Administering basic and advanced life support.
Assessing--data collection and analysis.
Diagnosing--identifying and prioritizing client problems.
Planning--stating expected outcomes and methods for achievement.
Implementing--interventions to achieve expected outcomes.
Evaluating--analysis of plan of care and client outcomes.
Caring for invasive lines (examples: PICC)
Feeding clients with oral or swallowing problems.
Administering blood and blood product transfusions.
Titrating medications based on specific client needs and physician orders.
Performing extensive or complex dressing changes or wound care.
Teaching of clients and families.
RNs主要負責一些複雜的侵入性操作和全面的體格檢查以及情況較為嚴重和不穩定患者的操作，還包括護理評估和診斷以及宣教方面的內容，當然LPN/LVN能做的一切也都是RNs的執業範圍。
The licensed practical/vocational nurse
Taking routine vital signs.
Providing basic life support.
Bathing, giving oral hygiene, and changing bed linens.
Turning and positioning.
Administering enemas, digital fecal removal.
Administering medications via PO, NG, PEG, IM, Z-track, intradermal, SQ, suppository, topical, and sublingual routes.
Administering instillations in the eyes, ears, nose, buccal muscosa, and rectum.
Administering enteral or tube feedings.
Monitoring blood glucose.
Oral suctioning.
Feeding clients without any oral or swallowing problems.
Performing simple dressing changes.
Inserting and removing Foley catheters.
Caring for ostomies.
Administering respiratory treatments.
Providing postmortem care.
Inserting rectal tubes.
Removing sutures and staples.
Caring for newborns including cord care, vital signs, and feeding.
Performing noncomplex procedures requiring sterile technique.
Documenting the care given to the client and the client’s response to that care.
Updating an initial assessment; the data that is collected by the LVN must be validated by the RN.
Reinforcing the teaching performed by the RN.
Teaching from a standard care plan, noncomplex teaching.
LPN/LVN做一些最基本的護理操作，包括除了靜脈液路、子宮內用藥等其他的灌注和肌注等給藥操作。可以進行初級評估，但是記錄的數據要由RN審核，還要對UAP做簡單的教學指導。
The unlicensed assistive person (UAP)
Obtaining routine vital signs.
Bathing, providing oral hygiene, changing bed linens.
Turning and positioning.
Feeding clients without any oral or swallowing problems.
Providing basic life support.
Providing postmortem care.
Ambulating. (Stable/noncomplex clients only)
Obtaining height and weight measurements.
Assisting with elimination.
Monitoring input and output (I & O).
Administering soapsuds enemas.
Assisting with general activities of daily living (ADLs).
Obtaining specimens.
Transferring clients with the use of proper body mechanics.
Documenting and reporting information related to client care to the RN.
Reporting unusual observations and symptoms reported by the client or observed to the RN.
Administering gastrostomy feedings (NO NG TUBE FEEDINGS)
Utilizing proper communication techniques.
Prioritizing tasks (per the direction of the RN or LPN/LVN).
Handling complaints.
UAP不能執行任何侵入性或無菌操作，也不能做任何對病人宣教的工作。
3、 充分了解了任務也明確了合適的人選，還要考慮委任的時間節點是不是合適。如果此時病人的病情因某些治療措施變得不穩定，有可能突發狀況，或者RN沒有辦法及時給與支援，又或者是你選的人還不熟悉工作環境，設備也不夠完善的情況下就不適合委任。
三、管理工作的原則
記住一定要分清輕重緩急，第一時間看那些more acute, unstable的患者，特別留意有生命危險的徵兆和併發症。
這類題目看起來讓人迷糊，不過記住我們最終的目的是有效的合作，而且在提高的工作的效率的同時還要保持高標準的護理服務。
閱讀更多 添翼國際護士培訓學校 的文章
