The home visiting process in the contexts of the voluntary vs. required visit: examples from fieldwork

Home visiting is a frequently used nursing intervention for families at risk. Yet, research on the nature of home visiting is lacking. Little empirical research has been conducted to corroborate or refine the definition of home visiting and phases of the home-visiting process. The "Hybrid Model of Concept Development" by Schwartz-Barcott and Kim (1986) was used to identify the nature of home visiting. The Hybrid Model combines theoretical analysis with empirical observation. The first phase includes theoretical analysis, continuing into the second phase, consisting of fieldwork. In the final analytical phase, theoretical findings are compared with the fieldwork findings. The completed review of historical and current literature and a definition of home visiting were presented earlier (Byrd, 1995). The findings of the fieldwork and final analytic phases are presented here. Two contexts of home visiting, "voluntary" and "required," emerged as distinctive. In the voluntary context, entry was relatively easily accomplished, interaction was client-controlled, and the tone was informal and friendly. In contrast, in the required context, entry was difficult, interaction was nurse-controlled, and the tone was formal, polite, and investigatory. Themes of resistance and distorted nurse-client communication emerged in this type of visit. Client characteristics and properties of the referral were contextual factors, influencing the process. The concept's initial definition was corroborated, and the model was expanded based on this empirical observation of maternal-child preventive home visits.