Role identity in a turbulent environment :the case of health visiting

Abstract

This thesis presents a grounded theory study of UK health visitors practising in an increasingly integrated, collaborative, service user focused healthcare system. Emphasis is placed in policy on a preventative, public health approach to addressing the ongoing health needs of the population. This has provoked a national debate on the healthcare contribution of health visitors. Better use of health visiting capacity and closer alignment of the role with the collaborative public health agenda have been identified as a national priority. The theoretical framework for this study has been developed from the symbolic interactionist premise, that individuals continually reinterpret their world in the context of their social interaction with others. Data has been collected from direct observation and individual interviews. The process of constant comparative analysis has generated four interrelated data categories: professional role in action; interprofessional working; local micro systems for practice and professional role identity (core category). Three models have been developed to support the discussion of the findings. The first two make explicit the inter-relationship between the concepts identified in the data and interactive processes relating to the maintenance of identity. The third model proposes a process of interprofessional role change. It links the uniprofessional and interprofessional dimensions of practice to the core principle of valuing individuals through the maintenance of equilibrium in their professional role identity. Embedding a process for feedback on identity is identified as important. This thesis theorises that role change facilitation should enable individuals to continually renegotiate their professional role identity in the context of their practice. It also suggests that promoting a sense of collective identity within a professional group will enhance the experience of individuals involved in a collaborative role change process. The thesis concludes with a consideration of its implications for health visiting and others in the healthcare system, in seeking to maintain their role identity in a turbulent practice environment.