# Situation: A public health nurse supervises the midwife and barangay health workers (BHWs) of a Barangay Health Station (BHS), which is linked to the Rural Health Unit (RHU), and oversees its records and referrals. The nurse reviews the referral system with the BHWs. Which statement by a BHW shows a need for **FURTHER** teaching?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627279  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: A public health nurse supervises the midwife and barangay health workers (BHWs) of a Barangay Health Station (BHS), which is linked to the Rural Health Unit (RHU), and oversees its records and referrals.

The nurse reviews the referral system with the BHWs. Which statement by a BHW shows a need for **FURTHER** teaching?

## 보기

1. "The referral slip should state why the client is referred and what was done."
2. "When a client returns with a back-referral slip, I help follow the care plan."
3. "We write a contact person on the slip so the receiving facility can reach us."
4. "Once a client is referred, the hospital takes over and we stop following up." **✔ 정답**

**정답: 4**

## 해설

A complete referral includes the client's identity, findings, care given, the reason for referral, and a contact person. Emergencies go directly to the nearest capable facility. Referral is two-way: back-referral returns the client with a care plan, and the community team follows up so that no client is lost between levels.

## 심화 해설

Understanding the referral system

Referral in primary health care is not a one-time handoff of a client. It is a two-way process that includes the initial referral from the community or primary level to a higher facility, and the back-referral that returns the client to the community team with a continuing care plan. The public health nurse, midwife, and BHWs remain responsible for follow-up even after the client is seen at the receiving facility.

A complete referral slip must state the reason for referral, the findings, the care already given, and a contact person for coordination. These elements allow the receiving facility to understand the client's situation and to communicate back to the referring team. When a client returns with a back-referral slip, the BHW helps implement the care plan at home or in the community, which maintains continuity of care.

The statement that shows a need for further teaching is: "Once a client is referred, the hospital takes over and we stop following up." This reflects a one-way, fragmented view of referral. In a functional referral system, the community team continues to track the client and resumes care after back-referral, so that no client is lost between levels.

| Element of referral | Correct understanding | Misconception |
| --- | --- | --- |
| Referral slip content | Includes reason, findings, care given, and contact person | Only the client's name and destination are enough |
| Direction of referral | Two-way: referral and back-referral | One-way transfer to a higher facility |
| Responsibility after referral | Community team follows up and supports the care plan | Hospital takes over; community stops following up |
| Emergency referral | Client goes directly to the nearest capable facility | Client waits for a regular appointment slot |

Fragmented referral systems lead to inefficiencies, coverage gaps, and compromised continuity and quality of care [1]. When the community team stops following up after referral, clients may not complete the recommended care or may not return with the back-referral slip, which breaks the continuity that primary health care depends on. In obstetric and emergency contexts, a functional referral pathway is essential to prevent preventable deaths, because delays in care or loss to follow-up can be fatal .

Key point! Referral is a loop, not a line. The BHW's role continues before, during, and after the client's visit to the receiving facility.References (research sources)

- [1]Optimizing people's movement across the health system: a scoping review of referral systems within a primary health care approach.Research articlePlummer ML, Calvello Hynes E, Fogarty J, Toro Polanco N, Reynolds T (2025) · DOI: 10.1017/S1463423625100546

## 임상 시나리오

Two-Way Referral Follow-UpCommunity team responsibility after referral
Referral is a two-way process: the initial referral goes to a higher facility, and back-referral returns the client with a continuing care plan.

A complete referral slip includes client identity, findings, care given, reason for referral, and a contact person.

After the client is seen, the community team must continue to track the client and resume care after back-referral.

CautionDo not treat referral as a one-time handoff; stopping follow-up can cause the client to be lost between levels.

## 핵심 개념

- **referral** — A two-way process of sending a client to a higher facility and receiving them back with a care plan
- **back-referral** — Return of the client to the referring community team with a continuing care plan
- **referral slip** — A form stating client identity, findings, care given, reason for referral, and contact person
- **continuity of care** — Ongoing follow-up across levels so no client is lost between facilities
- **BHW** — Barangay health worker who supports community-level care and follow-up

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