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Exploring the Professional Identity of Health Visitors 5 Key in This Article Keywords: Health visitor/Health Nursing Practice visiting/Professional identity Review ●This article has been double-blind Professional identity peer reviewed The health visiting role has evolved, changed and expanded over the years. How has this affected the professional identity of these practitioners? Exploring the professional identity of health visitors 5 key In this article... points A brief history of health visiting The role of Issues surrounding its professional identity 1health visitors Future challenges for the profession has been in flux since its conception in the Author Sharin Baldwin is professional lead poorer districts (Abbott and Wallace, mid-19th century for integrated children’s community 1998). “Respectable working women” were Health visitors’ nursing services, Harrow Community recruited to visit the homes of “the poorer 2role has Services, Ealing Hospital Trust. classes of the population”, to teach in a changed over the Abstract Baldwin S (2012) Exploring the range of different areas including hygiene, years and this has professional identity of health visitors. child welfare, mental health and social affected the Nursing Times; 108: 25, 12-15. support (While, 1987; McCleary, 1933), profession’s Health visiting is a complex, diverse tasks that still resonate with the health vis- identity and varied role. This article reviews itor role today. It has been the development of the role and how Although these “health missioners” are 3linked with this has affected health visitors’ the predecessors of health visitors, there is nursing despite the professional identity. some debate around when the first health different origins of visitors were employed (Dingwall, 1977). the two professions he profession of health visiting The title of “health visitor” was first used There is a has sparked debate on numerous in Manchester and in 1890 health visitors 4complex occasions about what constitutes were paid salaries by the local government relationship Tits professional identity, and (Heggie, 2011; Davies, 1988). From this between health whether indeed it has one. Health visitors point onwards other councils across the visiting and public have, through the years, been referred to as country began to employ health visitors. health “the mother’s friend”, “mini social By 1917, these practitioners were expected Agenda for workers” and “public health nurses”, to to visit all mothers as soon after a baby’s 5Change has name but a few. Although it “dips into” a birth as possible, to advise on hygiene and also impacted on number of related professions, such as infant care. Their duties were also being the profession nursing, education and social work, the extended to include visiting pregnant role of health visitors has been in flux since women, and children until they reached its conception in the mid-19th century. school age. This is still the case, as the current coali- After 1945 a number of significant tion government has pledged to create an changes took place. Nursing registration extra 4,200 health visitors, an improved became a requirement for health visitors training programme and a new vision and in 1945. After the NHS was formed in 1948, identity for the profession (Department of the widening of the health visiting role Health, 2011; Milton, 2010). caused confusion about whether their This article explores health visitors’ main professional relationship should lie identity from the start of the profession with GPs or medical officers of health and how the role has evolved, and con- (Malone, 2000). The Jameson Report siders what the future may hold. (Jameson, 1956) emphasised the impor- tance of maternal mental health, which Historical perspective became a key part of health visitors’ role Health visiting originated from the Ladies (Kelsey, 2000; Abbott and Wallace, 1998). Sanitary Reform Association, formed in This led to further confusion about health 1862 in Manchester and Salford in response visitors’ roles and those of social workers. A long-held practice: undertaking to the high infant mortality rate in the To address this confusion, Jameson routine reviews of babies 12 Nursing Times 19.06.12 / Vol 108 No 25 / www.nursingtimes.net Nursing For articles on community nursing, go to Times.net nursingtimes.net/communityanddistrict Family visits have been a core element of health visiting from its beginning (1956) made a clear distinction between the role once again, while health visitors combination of tasks that makes health these two groups (Kelsey, 2000). Health were also expected to work with individ- visiting a unique profession (Malone et al, visitors were described as generalist “case uals, be the lead nurse for safeguarding 2003; Cowley, 2002). finders” (through their universal access to children and lead on the delivery of the all families), while social workers were healthy child programme (DH, 2009a). Link to nursing identified as “case workers” (to work with The role has commonly been linked with families with identified problems) The health visitor’s role nursing despite the different origins of the (Malone, 2000). The lack of clear bounda- Hunt (1972a) suggested that “there seems two professions. However, if health vis- ries between the two roles continued to be to be a common feeling among health iting as a profession is distinct from problematic, especially in cases of safe- visitors that their role is difficult to inter- nursing then this raises the question of guarding children (Malone, 2000). pret to others, and that it is not well under- whether it is necessary for health visitors Health visiting was gradually incorpo- stood or agreed upon by those with whom to be qualified nurses before entering the rated into the new NHS structure by they work”. profession. This has been debated by pro- “attachment” to general practices. This Almost three decades later this has not fessionals for some time (Brocklehurst, change also meant health visitors became changed. As health visiting does not fit 2004; Malone et al, 2003). more involved with individualised med- neatly into just one category like some In 2002, this debate was further intensi- ical practice rather than the more commu- other professions, these practitioners have fied when health visitor regulation was nity-based public health approach (Sym- often been referred to as “jacks of all transferred from the United Kingdom Cen- monds, 1997). In 1974 health visiting was trades” (Hunt, 1972a; 1972b). tral Council for Nursing, Midwifery and moved from local authority control into Vague job titles and uncertainty over Health visiting (UKCC) to the Nursing and the NHS. In 1977, four principles for health the associated roles potentially create Midwifery Council (NMC), a regulatory visiting practice were published: ambiguity and confusion about profes- body whose title did not include the phrase » Search for health needs; sional identity (McGillivray, 2008). The “health visiting”. Health visitors moved » Stimulate an awareness of health needs; title “health visiting” has been criticised from having a unique professional regis- » Influence policies affecting health; for not being explicit in describing what tration to being registered with the NMC » Facilitate health-enhancing activities the title-holder does (Hunt, 1972a), unlike under “specialist community public (Council for the Education and other professional groups where the roles health nurses”. Considering the two serv- Training of Health Visitors, 1977). are clearer, such as nurses and teachers. ices’ differences in organisation and pur- Public health became a national focus However, Cowley (2002) argued that the pose, and that health visitors require an from the 1990s, when government policies title does explain what they do – “health additional qualification, categorising recognised health visitors’ vital role in visitors do health visiting”, an umbrella health visiting under the broader improving health and tackling inequali- term encompassing a range of different “nursing” title could be seen as dimin- ties. The need to strengthen health visi- activities. Although social workers, com- ishing the significance of health visiting as tors’ public health role and work in new munity nurses, public health workers, a profession. Furthermore, there is no ways was highlighted in a number of docu- children’s centre workers and outreach research to show any benefits of treating ments (DH, 2001; 1999a; 1999b). Public workers may all be involved in providing a health visiting as a branch of nursing, health thus became a major component of range of different activities, it is the while there is increasing evidence that it Alamy, Report digital www.nursingtimes.net / Vol 108 No 25 / Nursing Times 19.06.12 13 Nursing Practice Review causes harm to health-visiting education, fragmenting the core function of health with health visiting through association the regulatory process and therefore to visiting by reducing it to a series of task- with colleagues in a professional organisa- practice (Cowley et al, 2000). oriented, routinised approaches that tion (Adams et al, 2006; Hunt, 1972a). mirror a medicalised model (Smith, 2004; Although health visitors’ role overlaps Public health Craig and Smith, 1998). Besides the confu- with a number of other professions, which There is a complex relationship between sion surrounding public health, health may pose a threat, it is the combination of health visiting and public health. In 1999, visitors also face an identity crisis over the health promotion, safeguarding children,
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