Conflicting paradigms of health visiting: a continuing debate for professional practice

The interpretation of health visiting practice has formed the focus of a professional debate amongst practitioners and those involved in health visiting education for many years. More recently, changes in nurse education, government legislation and general anxiety about the future of health visiting have added to the intensity of the debate. In re-examining the conceptual origins of health visiting, this paper proposes one possible explanation for this phenomenon in which the author describes four conflicting paradigms of practice. The author argues that it is the tendency of practitioners to adopt one specific paradigm of practice which has contributed to the continuing debate and current professional uncertainty experienced by health visitors. The authors goes on to suggest a conceptual framework for practice developed from an epistemology of practice grounded in reflection in practice and the principles of health visiting. It is argued that this approach to practice allows practitioners to reconsider their practice in terms of the values and beliefs underpinning health visiting rather than identified tasks and client groups. It may also provide practitioners with the opportunity of developing and adapting strategies to meet current health needs rather than the traditions of practice.