# Situation: The public health nurse follows up a family in an urban barangay. The son, 9, has cerebral palsy and uses a wheelchair; the house has two steps at the entrance and raised door thresholds. The mother, 36, is his only caregiver and also looks after a 2-year-old daughter. The father, 40, will leave next month to work abroad for 2 years. The mother says, "We stopped going to the free therapy sessions at the city health center. Last time, a staff member scolded me in front of the other mothers because we arrived late. The sessions were helping him, but I will not go back there." Which reason BEST explains the family's inability to use community resources?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627142  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse follows up a family in an urban barangay. The son, 9, has cerebral palsy and uses a wheelchair; the house has two steps at the entrance and raised door thresholds. The mother, 36, is his only caregiver and also looks after a 2-year-old daughter. The father, 40, will leave next month to work abroad for 2 years.

The mother says, "We stopped going to the free therapy sessions at the city health center. Last time, a staff member scolded me in front of the other mothers because we arrived late. The sessions were helping him, but I will not go back there." Which reason BEST explains the family's inability to use community resources?

## 보기

1. Lack of knowledge of the resources that are available
2. An unpleasant experience with the health personnel **✔ 정답**
3. Failure to see the benefits of the available service
4. Inaccessibility of the service because of distance or cost

**정답: 2**

## 해설

The family knows the service exists, has reached it before, and saw that it helped, so knowledge, access, and perceived benefit are intact. The mother refuses to return because of how she was treated, which is an unpleasant experience with health personnel. The plan addresses this reason, for example by coordinating with the center to restore her trust, rather than by more teaching about the service.

## 심화 해설

Scenario analysis

The family has already demonstrated three of the four prerequisites for using a community service. The mother knows the free therapy sessions exist, she has physically reached the facility before, and she explicitly states that “the sessions were helping him.” Therefore, lack of knowledge, inaccessibility, and failure to perceive benefit are not the operative barriers. What changed is her willingness to return after being publicly reprimanded by a staff member in front of other mothers.

In community health nursing, utilization of a resource depends not only on availability and perceived value but also on the therapeutic relationship between the family and the service provider. A single negative interpersonal encounter can outweigh objective benefits, particularly when the caregiver is already under strain. This mother is the sole caregiver for a child with cerebral palsy and a toddler, and the father’s upcoming departure for two years will further reduce her support. Her decision to stop attending is a protective response to humiliation, not a misunderstanding of the service’s purpose.

Key point! The correct answer is 2 because the barrier is emotional and relational, not informational, geographic, or financial. The nursing intervention must therefore target restoring trust—for example, by coordinating with the health center to arrange a respectful re-entry, clarifying the lateness policy privately, or assigning a different staff member—rather than providing more teaching about the service.

| Option | Why it is not the best explanation |
| --- | --- |
| 1. Lack of knowledge | The mother names the service, its location, and its schedule; she has attended previously. |
| 3. Failure to see benefits | She states the sessions “were helping him,” so perceived benefit is intact. |
| 4. Inaccessibility | Distance and cost are not mentioned as barriers; she reached the center before. |
| 2. Unpleasant experience | The scolding in front of peers created shame and eroded trust, which is the actual reason for refusal. |

The family’s physical environment—two entrance steps and raised door thresholds—does present real accessibility challenges for a wheelchair user. However, the mother’s stated reason for discontinuing therapy is not architectural; it is interpersonal. A thorough public health nurse assessment would note both issues, but the question asks for the best explanation of the family’s inability to use the resource, and the mother’s own words point directly to the humiliating encounter.

Watch out! In licensure examinations, when a scenario includes multiple potential problems, the correct answer is the one that matches the client’s stated reason or the most immediate modifiable barrier. Do not select a structural issue such as steps or cost when the client has clearly identified a relational one.

From a nursing process perspective, this finding belongs in the assessment phase and informs the diagnosis of ineffective family health management or impaired verbal communication between family and provider. The planning phase would prioritize rebuilding a collaborative relationship with the health center, because without trust, even the most evidence-based therapy program cannot be delivered.

## 임상 시나리오

Rebuilding Trust After a Negative Clinic EncounterAddressing relational barriers to service use in community health
When a family stops attending a service they previously used and valued, assess for interpersonal or emotional barriers before assuming lack of knowledge or access. A single humiliating encounter with staff can override objective benefits, especially for caregivers under high strain.

The public health nurse should first acknowledge the mother's experience without defensiveness, then coordinate with the health center to arrange a respectful re-entry. Options include clarifying lateness policies privately, assigning a different staff member, or scheduling a less crowded time slot.

CautionDo not respond with more teaching about the service or dismiss the incident as minor. The barrier is relational, not informational. Rebuilding trust must precede any attempt to re-engage the family in therapy.

## 핵심 개념

- **Therapeutic relationship** — A trusting, respectful connection between healthcare provider and client that influences continued use of services.
- **Health-seeking behavior** — Actions a person takes to obtain healthcare, shaped by perceived benefit, access, and past experiences.
- **Barriers to care** — Factors that prevent or discourage use of health services, including interpersonal, geographic, financial, and informational.
- **Caregiver burden** — Physical, emotional, or social strain experienced by a person providing ongoing care to a dependent family member.
- **Community resource utilization** — The extent to which families access and continue using available local health and social services.

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