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 th e introduction of general management and shift to a market-place orien tation, 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 ex actly what it is that they do. This has often been portrayed as a majo r failing, and possibly even a reason to discontinue the service, This paper will offer a potential explanation for this difficulty, and sug gest that the management of uncertainty and ambiguity are central to t he role, It will draw on a grounded theory study which explored how he alth visitors choose which approach to use in any particular situation encountered in their work. The analysis suggested that health visitin g'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 rec ognize and respond to complex, potentially risk-filled situations. Dra wing on examples which illustrate the implications of these concepts i n practice, the paper suggests that, much as midwives have long claime d 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 pla ce. Nevertheless, it will be contended that the particular approach to practice revealed in this study represents a valuable and necessary a spect of health promotion, which has the potential to ensure relevance and acceptability, and which maximizes unexpected opportunities for p revention.