Changes in health visitors' work

The purpose of this investigation is to describe Scottish health visitors (HVs) experience of changes in their work and compare these with their Norwegian counterparts.

The renewed emphasis on community health care, health promotion and illness prevention is a strong reason to focus on health visiting work. Knowledge about changes in practice are of special interest for nursing science as such knowledge could contribute to the development and advancement of the health visiting service.

The study used a comparative descriptive design. The data are based upon in-depth interviews with nine HVs from Scotland and 12 HVs from Norway.

The results showed similarities as well as differences. HVs in Scotland and Norway experienced changes in work load with decreases in some areas and increases in others, changes in work practice, approaches and techniques with more emphasis on clients' empowerment, and also fewer management positions held by nurses. The differences mainly related to the ways that the health visiting service had specialized and expanded. The aim of Scottish health visiting from 'cradle to grave' service was not adopted by the Norwegian HVs to the same extent. Scottish HVs specialized individually in some areas and used each other's competence to a much greater degree than the Norwegian HVs.

It appeared that the Scottish HVs had found a path where health visiting work aimed at illness prevention and health promotion for everyone was on the way to becoming a comprehensive service and a stronger and more integrated part of the health visiting service. This is a pathway that Norwegian HVs still have to pursue. The qualitative approach and the slightly different samples limited the possibility for generalizations. Further research should address the question of changes and patterns in health visiting work, of how the development came about, and what are the bases for the differences in specialization and expansion of the service. Secondly it should be asked to what degree the development influences the quality of health visiting and consequences for clients, community and health visiting service.