'Sticking to carpets' - assessment and judgement in health visiting practice in an era of risk: a qualitative study

Abstract

Aim and objective: This paper aims to explore health visitors' accounts of assessment and judgement in health visiting in the context of policy change and an increased focus on risk, which is reshaping practice.

Background: Assessment and judgement underpin the targeting of support in health visiting practice. Existing literature suggests that needs assessment in health visiting is a complex process which draws on different types of knowledge.

Methods: The study, upon which this paper draws, was a qualitative exploration which aimed to explore the impact of policy change on health visiting practice and on families. The accounts of sixteen health visitors, who took part in semi-structured interviews, are reported. The interview data were analysed using thematic and narrative techniques.

Results: Health visitors' accounts of their observations of families' homes, relationships and practices, such as their references to 'dirt', harmful practices and appropriateness, illustrate ways in which assessment and judgement in health visiting practice are shaped by a discourse of risk and notions of ideal parenting. Health visitors problematise this discourse in relation to the potential stigmatising impacts for families. Although health visitors indicate ambivalence towards the use of assessment tools, the findings indicate that they feel the tools provide them with a safety-net at a time when their practice is being reshaped by a discourse of risk.

Conclusion: This paper identifies that assessment and judgement in contemporary health visiting are shaped by a discourse of risk. A discussion of the role of 'emotion in use' and collective emotions provides an appropriate theoretical lens to consider the impact that risk discourse has on health visiting practice and on families.

Relevance to clinical practice: This study highlights the need for assessment and judgement in health visiting practice to be highly reflexive, to support families in an era of risk.

Keywords: collective emotion; community nursing/health visiting; health policy; needs assessment; qualitative methods; risk discourse.