# Situation: The nurse is a case manager in a community mental health program that a provincial hospital runs with the Rural Health Units (RHUs). The program follows adults with severe mental illness after discharge and works with the municipal health officer, social workers and trained barangay health workers (BHWs). A 38-year-old man with schizophrenia lives with his mother in a coastal barangay. He receives a long-acting antipsychotic injection every 4 weeks at the RHU. Which task may the nurse assign to the trained BHW?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630257  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: The nurse is a case manager in a community mental health program that a provincial hospital runs with the Rural Health Units (RHUs). The program follows adults with severe mental illness after discharge and works with the municipal health officer, social workers and trained barangay health workers (BHWs).

A 38-year-old man with schizophrenia lives with his mother in a coastal barangay. He receives a long-acting antipsychotic injection every 4 weeks at the RHU. Which task may the nurse assign to the trained BHW?

## 보기

1. Give his injection at home if he misses his clinic visit
2. Lower his antipsychotic dose when he reports stiffness
3. Visit him weekly and remind him of his next clinic date **✔ 정답**
4. Judge whether his voices are worse and change his plan

**정답: 3**

## 해설

Barangay health workers support primary health care through home visits, reminders about follow-up, health education and referral. Giving injections, changing doses and making clinical judgments are not within their role; the nurse supervises the BHW and acts on what the BHW reports.

## 심화 해설

The correct answer is 3. Visit him weekly and remind him of his next clinic date.

This question tests your ability to distinguish between tasks that can be safely delegated to a trained community health worker and tasks that must remain with a licensed nurse or other qualified clinician. The core principle is that delegation must match the worker’s training, legal scope of practice, and the level of clinical judgment required.

Task sharing and task shifting are strategies used to expand access to care in underserved areas, but they are not the same as unrestricted delegation. The World Health Organization originally described task shifting as moving specific tasks from higher-qualified to lower-qualified workers, while subsequent work has emphasized task sharing as a collaborative, team-based redistribution of responsibilities [1]. In either model, the tasks assigned must be clearly defined, protocol-driven, and within the worker’s competency.

A trained barangay health worker (BHW) supports primary health care through activities that do not require independent clinical decision-making. These include home visits, health education, follow-up reminders, and referral. In the context of a community mental health program, a BHW can visit a client weekly, observe for changes in behavior or self-care, and remind the client of the next scheduled clinic appointment. This is a supportive, monitoring, and linkage function — not a treatment decision.

Visiting the client and reminding him of his next clinic date is appropriate because it is a reminder and observation task, not a clinical intervention. The BHW reports observations to the nurse, who then makes any needed clinical decisions.

Let’s examine why the other options are incorrect.

Option 1: Give his injection at home if he misses his clinic visit

Administering a long-acting antipsychotic injection is a medication administration task. It requires knowledge of injection technique, medication action, side effects, and the ability to assess the client before giving the dose. In most settings, medication administration — especially parenteral medication — is restricted to licensed professionals such as nurses or physicians. Watch out! Even if a BHW has received basic first-aid training, giving an antipsychotic injection is outside the BHW role and would be unsafe delegation.

Option 2: Lower his antipsychotic dose when he reports stiffness

Stiffness may indicate an extrapyramidal side effect such as dystonia or parkinsonism from the antipsychotic. Adjusting a medication dose is a prescribing or clinical decision that requires assessment of the severity of the symptom, the client’s overall status, and the risk-benefit of changing the dose. A BHW cannot make this judgment. The nurse must assess the client and consult with the prescribing provider. Key point! Dose adjustment is never a delegated task.

Option 4: Judge whether his voices are worse and change his plan

Evaluating the severity of auditory hallucinations and modifying the treatment plan requires clinical judgment about psychotic symptoms, insight, safety risk, and response to treatment. This is a core nursing and psychiatric assessment function. A BHW can report what the client says or does, but cannot interpret whether the voices are “worse” in a clinical sense or alter the care plan.

The literature on task sharing in mental health consistently shows that non-specialist community health workers can effectively deliver structured, protocol-based psychosocial interventions — such as a six-session psychological treatment for antenatal depression delivered by community health workers in South Africa . However, those interventions are carefully scripted and supervised. They do not include medication management or independent diagnostic judgment.

Similarly, reviews of skill-mix solutions in rural areas emphasize that task shifting works when tasks are transferred with clear protocols, training, and supervision . The transfer of selected tasks between professions is possible, but the tasks must be within the receiving worker’s scope. In the Philippine primary health care system, the BHW role is explicitly supportive and preventive, not curative or prescriptive.

| Task | Can a trained BHW do it? | Reason |
| --- | --- | --- |
| Home visit and appointment reminder | Yes | Supportive, observational, no clinical judgment required |
| Give antipsychotic injection | No | Medication administration is a licensed nursing task |
| Lower antipsychotic dose | No | Dose adjustment requires prescriber-level clinical judgment |
| Judge severity of voices and change plan | No | Psychiatric assessment and care plan modification are nursing/medical functions |

The nurse supervises the BHW and acts on what the BHW reports. The BHW is the eyes and ears in the community, but the nurse retains accountability for assessment, clinical decisions, and interventions. This aligns with the principle that task sharing is collaborative — the BHW and nurse work as a team, but the nurse holds the clinical authority [1].

In a community mental health follow-up program, the weekly home visit by a BHW serves a critical function: it maintains contact with a client who has a severe mental illness, reduces the risk of loss to follow-up, and provides early warning of deterioration. The BHW can remind the client of the next RHU appointment for the long-acting injection, which is scheduled every 4 weeks. If the client misses the appointment, the BHW reports this to the nurse, who then arranges outreach or rescheduling. The BHW does not independently intervene.

Key point! When a question asks what you may delegate to a community health worker, look for the option that involves reminding, observing, reporting, or referring — not assessing, medicating, or deciding.References (research sources)

- [1]Distinguishing task shifting from task sharing through the delegating provider's presence or absence: proposed operational definitions.Research articleDas S, Grant L. (2026) · DOI: 10.7189/jogh.16.03034

## 임상 시나리오

Delegation to BHWs in Community Mental HealthSafe task assignment for schizophrenia follow-up
A trained barangay health worker may perform home visits, provide health education, remind the client of the next clinic appointment, and report observations to the supervising nurse.

Tasks requiring clinical judgment—such as giving long-acting antipsychotic injections, adjusting doses for extrapyramidal symptoms, or evaluating auditory hallucinations—must remain with the licensed nurse or physician.

CautionNever delegate medication administration or dose changes to a BHW, even if the client misses a clinic visit. The nurse must assess the client and act on the BHW's report.

## 핵심 개념

- **Task Shifting** — Moving specific, protocol-driven tasks from higher-qualified to lower-qualified health workers to expand access to care.
- **Task Sharing** — A collaborative, team-based redistribution of responsibilities among health workers with different qualifications.
- **Barangay Health Worker (BHW)** — Trained community health worker in the Philippines who provides basic primary care support, including home visits and health education.
- **Long-acting injectable antipsychotic** — A medication formulation given by injection at intervals (e.g., every 4 weeks) to maintain therapeutic levels and improve adherence.
- **Clinical Judgment** — The cognitive process of assessing, interpreting, and deciding on patient care actions, which requires professional licensure.

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