Health-as-process: a health visiting perspective

Health visitors are community nurses who define their role specifically in terms of health promotion, although they have often found difficulty in explaining how their seemingly diffuse and unfocused practice achieves this. The grounded theory study reported here set out to uncover some of the hidden processes and features embedded within health visiting, so the practice might be more clearly articulated. This paper reports one aspect of that study, which suggests that health visitors treat health as a lifelong process, involving the accumulation and use of 'resources for health'. The relevance of approaches which appeared both caring and educational will be set in the context of therapeutic nursing and adult education theories. Historically, health visitors have links with both nursing and health education; the analysis presented here helps to clarify the relationships between these different areas of work. The paper will explain how treating health as a process allows multiple competing views and ideas about health and health promotion to be integrated into a manageable form, thus allowing positive health to be promoted within a broad, acceptable socio-cultural context. However, the analysis also highlighted various points at which treating health as a process contradicts the firmly measurable requirements of the market-orientated health service. Nevertheless, where health visitors are sufficiently skilled, and are permitted by their employing authorities to use this approach, it may serve to protect clients from intrusive and accusing interventions, made in the name of health promotion.