# Situation: The father, 40, a construction worker, has bacteriologically confirmed pulmonary tuberculosis (TB) and started treatment 2 months ago at the Rural Health Unit (RHU), 12 km from home. The family of five lives in a one-room house with small windows that are kept closed. The children are 3, 7, and 12 years old. A barangay health station (BHS) with a midwife is within walking distance of the home. The mother says, "We know he must take his medicines every day until the end, and we have decided he will finish them. But he lost his job, and we cannot pay the daily fare to the RHU, so he has missed many doses." Which family nursing problem does this statement BEST support?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627246  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The father, 40, a construction worker, has bacteriologically confirmed pulmonary tuberculosis (TB) and started treatment 2 months ago at the Rural Health Unit (RHU), 12 km from home. The family of five lives in a one-room house with small windows that are kept closed. The children are 3, 7, and 12 years old. A barangay health station (BHS) with a midwife is within walking distance of the home.

The mother says, "We know he must take his medicines every day until the end, and we have decided he will finish them. But he lost his job, and we cannot pay the daily fare to the RHU, so he has missed many doses." Which family nursing problem does this statement BEST support?

## 보기

1. Inability to recognize the presence of the health problem
2. Inability to provide a home environment conducive to health
3. Inability to make decisions about appropriate health action
4. Inability to use community resources for health care **✔ 정답**

**정답: 4**

## 해설

The family understands the disease and the need for daily treatment and has decided to continue it, so recognition and decision-making are intact. The barrier is the cost of reaching the health facility, which is inability to use community resources due to lack of financial resources. The plan should reduce this barrier rather than repeat teaching about the disease.

## 심화 해설

Scenario analysis

The family has already demonstrated accurate recognition of the health problem and has made a firm decision to complete treatment. The mother’s statement does not reflect misunderstanding of TB or reluctance to act. The central issue is that the father cannot afford the daily transportation fare to the RHU, which is 12 km from home, and has therefore missed many doses. This is a structural, resource-related barrier rather than a knowledge or decision-making deficit.

The family’s difficulty is best classified as an inability to use community resources for health care because the obstacle is financial access to the treatment facility, not a lack of understanding or motivation. In family nursing diagnosis terms, the problem lies in the family’s capacity to mobilize available health services under economic constraint.

Watch out! The presence of a nearby BHS with a midwife is an important clue. The family is not failing to recognize that health services exist; rather, the services they need for daily TB medication are located at the RHU, and the cost of reaching that specific facility is the barrier. This distinguishes “inability to use community resources” from “inability to recognize the presence of the health problem.”

| Family nursing problem | Why it does not fit this situation |
| --- | --- |
| Inability to recognize the presence of the health problem | The mother states the father has TB and must take medicines daily until the end; recognition is intact. |
| Inability to provide a home environment conducive to health | The one-room house with closed windows is a separate concern, but the mother’s statement focuses on transportation cost, not the physical home environment. |
| Inability to make decisions about appropriate health action | The family has already decided to finish treatment; decision-making is not impaired. |
| Inability to use community resources for health care | Correct. The barrier is the daily fare to the RHU, which prevents consistent use of the available TB treatment service. |

Evidence from TB care access studies supports this interpretation. In rural Ethiopia, transport cost exceeding US $1.40 and transport time over 2 hours were significantly associated with delayed presentation to TB services [2]. This illustrates that even when patients recognize the need for care, the direct cost of reaching a health facility can independently delay or interrupt treatment. The father’s missed doses are consistent with this pattern: the family understands the treatment requirement, but the daily fare is an insurmountable recurring expense after job loss.

Qualitative findings from The Gambia similarly describe how access to TB treatment is shaped by practical and economic constraints rather than knowledge alone . Patients and families may fully accept the diagnosis and the need for treatment, yet still struggle to attend services because of transportation and related costs. This reinforces the principle that a family nursing assessment must distinguish between cognitive barriers such as knowledge deficits and structural barriers such as financial access.

Reviews of structural barriers to TB care in low- and middle-income settings further emphasize that poverty-related obstacles such as transport costs are among the most common reasons for treatment interruption . These barriers are not solved by repeating health education. Instead, the nursing intervention should focus on reducing the access barrier, for example by exploring directly observed treatment at the nearby BHS, arranging community-based treatment support, or linking the family to social welfare or transport assistance programs.

Key point! The family’s statement points to a resource-use problem, not a knowledge or decision-making problem. The priority nursing action is to facilitate access to the existing TB treatment service by addressing the transportation cost barrier, not to re-teach the disease process.

References (research sources)

- [2]Rural poverty and delayed presentation to tuberculosis services in Ethiopia.Research articleCambanis A, Yassin MA, Ramsay A, Bertel Squire S, Arbide I, Cuevas LE (2005) · DOI: 10.1111/j.1365-3156.2005.01393.x

## 임상 시나리오

TB Treatment Access BarrierWhen cost, not knowledge, blocks adherence
The family already recognizes the diagnosis and has decided to complete treatment. The real problem is inability to use community resources because the daily fare to the RHU, 12 km away, is unaffordable after job loss.

Prioritize removing the access barrier over repeating disease education. Explore options such as treatment closer to home, BHS-based DOT, or community treatment partners.

CautionDo not mislabel this as a knowledge or decision-making deficit. The nearby BHS has a midwife but may not dispense daily TB medications; verify what services the BHS can actually provide before referring.

## 핵심 개념

- **Family nursing problem** — A clinical judgment about a family's response to actual or potential health conditions or life processes, guiding nursing interventions.
- **Inability to use community resources for health care** — A family nursing diagnosis where the family cannot access or mobilize available health services due to barriers such as cost, distance, or lack of knowledge about resources.
- **TB DOTS** — Directly Observed Treatment, Short-course; the standard strategy for tuberculosis treatment requiring daily medication adherence until completion.
- **Rural Health Unit** — A primary-level government health facility in the Philippines providing basic health services including TB treatment.
- **Financial barrier** — An economic obstacle, such as transportation cost or lost income, that prevents a patient from accessing needed health care.

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