In health visiting, a routine visit is one that has passed

Pressure on British health workers to be more explicit in articulating the function, purpose and outcome of their role has increased with the introduction of general management and shift to a market-place orientation, since implementation of the NHS and Community Care Act (1990) However, a recurring theme in the history of health visiting has been the difficulty which practitioners experience in trying to explain exactly what it is that they do This has often been portrayed as a major failing, and possibly even a reason to discontinue the service This paper will offer a potential explanation for this difficulty, and suggest that the management of uncertainty and ambiguity are central to the role It will draw on a grounded theory study which explored how health visitors choose which approach to use in any particular situation encountered in their work The analysis suggested that health visiting's central focus is on situations which are unpredictable, ambiguous or anomalous The study revealed an approach to health promotion which requires a highly developed ability to cope in a safe and therapeutic way with shifting, uncertain and ill-defined health needs, and to recognize and respond to complex, potentially risk-filled situations Drawing on examples which illustrate the implications of these concepts in practice, the paper suggests that, much as midwives have long claimed that a'normal delivery is one that is over, so in health visiting a'routine visit'can only be recognized as such once it has taken place Nevertheless, it will be contended that the particular approach to practice revealed in this study represents a valuable and necessary aspect of health promotion, which has the potential to ensure relevance and acceptability, and which maximizes unexpected opportunities for prevention     

Meaning of illness for women with breast cancer

The meaning that women with breast cancer ascribe to their disease may well have an impact on the effectiveness of coping strategies used to come to terms with breast cancer Health rare professionals need to know what meanings women with breast cancer are ascribing to their disease if they are to identify maladaptive coping strategies and ensure that women receive the support that they need in order to promote physical and psychological recovery This study involved assessing meaning of illness for a group of women with breast cancer at two points in time, the time of diagnosis and a mean of 21 months from diagnosis The eight meanings of illness devised by Lipowski were depicted by the following words challenge, enemy, punishment, loss, strategy, relief, weakness and value The most popular choice of meaning for the women was challenge, although some women's choices indicated that maladaptive coping strategies were being used The implications of the study for nurses and other health care professionals are discussed