# Situation: The public health nurse at a Barangay Health Station (BHS) is assessing a newly registered family. The father, 30, is a tricycle driver; the mother, 27, is a homemaker; their only child is a 20-month-old son; and the mother's widowed mother, 62, lives with them. No member has a current illness, and the son's immunizations are complete for his age under the National Immunization Program (NIP). With the family, the nurse draws a diagram of the family's ties with groups outside the home. It shows: - Thick (strong) lines to the church and to the father's drivers' association - A thick line to the mother's siblings in the next barangay - A jagged (stressful) line to a lending group from which the family borrowed money - A thin, broken (weak) line to the BHS Which interpretation is BEST supported by the diagram?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627040  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse at a Barangay Health Station (BHS) is assessing a newly registered family. The father, 30, is a tricycle driver; the mother, 27, is a homemaker; their only child is a 20-month-old son; and the mother's widowed mother, 62, lives with them. No member has a current illness, and the son's immunizations are complete for his age under the National Immunization Program (NIP).

With the family, the nurse draws a diagram of the family's ties with groups outside the home. It shows:
- Thick (strong) lines to the church and to the father's drivers' association
- A thick line to the mother's siblings in the next barangay
- A jagged (stressful) line to a lending group from which the family borrowed money
- A thin, broken (weak) line to the BHS
Which interpretation is BEST supported by the diagram?

## 보기

1. The family's main source of stress lies within its own household
2. The family is socially isolated and has few outside sources of support
3. The family's tie with health services is weak and needs strengthening **✔ 정답**
4. The family carries a hereditary risk that needs early screening

**정답: 3**

## 해설

An ecomap shows the family's links with outside systems; line types show strong, weak, or stressful ties. Here the only weak tie is to the BHS, so the family has little connection with health services, a gap the nurse can strengthen for health promotion. The strong ties to church, the association, and relatives are resources, and the stressful tie is to an outside lending group.

## 심화 해설

Core interpretation

An ecomap is not a drawing of the family’s internal structure; it maps the family’s connections to systems outside the household. In this scenario, the diagram shows strong ties to the church, the father’s drivers’ association, and the mother’s siblings, while the only weak tie is to the Barangay Health Station. The jagged line to the lending group indicates a stressful external relationship, not a stressor arising inside the home. Therefore, the best-supported interpretation is that the family’s link with health services is weak and represents a gap the nurse can strengthen.

Watch out! Do not confuse an ecomap with a genogram. A genogram shows family structure, relationships, and health history across generations. An ecomap shows the family’s relationships with outside systems such as schools, workplaces, churches, health services, and community groups.

Why option 3 is correct

The line from the family to the BHS is described as thin and broken, which in ecomap notation indicates a weak or tenuous connection. Since the BHS is the local health service, this finding directly supports the interpretation that the family has limited linkage with health services. For a family with a 20-month-old child and a 62-year-old older adult, this weak tie matters because health promotion, growth monitoring, immunization follow-up, and screening for age-related conditions all depend on a functional connection with the health system. The nurse can use the ecomap to identify this gap and plan interventions that build a stronger therapeutic relationship.

Why the other options are not supported

| Option | Why it is not the best answer |
| --- | --- |
| 1. Main source of stress lies within the household | The stressful line points to an outside lending group, not to relationships inside the home. An ecomap does not primarily assess internal family dynamics. |
| 2. Family is socially isolated | The diagram shows multiple strong ties to the church, the drivers’ association, and relatives. Social isolation is not supported by the thick lines. |
| 4. Hereditary risk needs early screening | Hereditary risk is assessed through a genogram and family health history, not through an ecomap of external ties. No data in the scenario suggest a genetic concern. |

Clinical and public health application

In family nursing practice, the ecomap serves as both an assessment tool and an intervention. The process of constructing the map with the family helps the nurse understand how the family perceives its own support network. The quality of each connection is shown by the type of line: a thick line represents a strong, supportive bond; a thin or broken line represents a weak or fragile tie; and a jagged line represents a stressful or conflicted relationship. These visual conventions allow the nurse to quickly identify resources that can be mobilized and gaps that require strengthening.

Key point! Strong ties are assets. The church, the drivers’ association, and the mother’s siblings are potential sources of emotional, instrumental, and informational support. The nurse can involve these resources when planning care for the child’s development or the older adult’s health maintenance.

The weak tie to the BHS is especially important from a public health perspective. A family that rarely connects with the health station may miss scheduled immunization follow-ups, growth monitoring, nutrition counseling, and screening services. For the 20-month-old child, continued monitoring remains relevant even though immunizations are complete for age. For the 62-year-old grandmother, preventive services such as blood pressure screening and health education become increasingly important. The ecomap therefore helps the nurse prioritize relationship-building with this family rather than assuming that the absence of current illness means no need for health services.

The stressful tie to the lending group is also clinically meaningful. Financial strain from debt can affect the family’s ability to access transportation, food, and health care. The nurse can acknowledge this stressor without misinterpreting it as an internal family problem. The ecomap places the stressor outside the household, which helps the nurse avoid blaming the family and instead explore community resources or social support options that may reduce the burden.

## 임상 시나리오

Ecomap Interpretation in Family Health AssessmentUsing line types to identify gaps and resources
An ecomap maps the family's connections to outside systems, not internal family structure. Line types carry meaning: thick lines indicate strong ties, thin broken lines indicate weak ties, and jagged lines indicate stressful ties.

In this family, the only weak tie is to the BHS, meaning the family has limited connection with health services. Strong ties to the church, the drivers' association, and relatives are support resources, while the jagged line to the lending group is an external stressor.

CautionDo not confuse an ecomap with a genogram. A genogram shows family structure and hereditary risk; an ecomap shows outside system links. The weak BHS tie is a modifiable gap the nurse can strengthen for health promotion, growth monitoring, and screening.

## 핵심 개념

- **Ecomap** — A diagram of a family's connections to outside systems such as health services, church, work, and community groups, using line types to show strong, weak, or stressful ties.
- **Genogram** — A diagram of family structure, relationships, and health history across generations, used to identify hereditary patterns.
- **Thin broken line** — In ecomap notation, indicates a weak or tenuous connection between the family and an outside system.
- **Jagged line** — In ecomap notation, indicates a stressful or conflicted relationship with an outside system.
- **Barangay Health Station (BHS)** — The local primary health care facility in the Philippines where public health nurses provide health promotion, immunization, and screening services.

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