Jurisdiction in community nursing services

The experience of collaboration: a comparison of health visiting in Scotland and Norway

This investigation compared health visiting in Scotland and Norway by focusing on collaboration in health visiting. The data are based upon in-depth interviews with a non-probability sample, with voluntary participation of nine health visitors from Scotland and 12 health visitors from Norway. The results showed that there were more similarities than differences between the Scottish and Norwegian health visitors' experience of collaboration in their work. Both groups had a complex role-set and experienced dependency on role partners. Collaborative strain was experienced through lack of recognition and system deficiencies. Tensions in collaboration evolved from the definition and question of responsibility in grey areas, jurisdictional threats and conflicts. Within these areas the degree and importance of collaboration differed. The Scottish health visitors were more dependent on client referrals to them and their referrals to other agencies, whereas the Norwegians health visitors experienced an asymmetrical relationship, as they were more dependent on the capacity of the agency to accept the referrals. Lack of recognition seemed to be a stronger experience in Norway than in Scotland. All of this had a marked influence on the performance of the health visitors. Further research should address the question of collaboration in health visiting work and to what degree it influences the quality of health visiting and consequences for clients, the community and health visiting service.

Health visiting in Scotland and Norway: commonalties and differences

This investigation compared health visiting in Scotland and Norway by focusing on health visitors' influence on management matters, work tasks and work conditions. The data are based upon in-depth interviews with nine health visitors from Scotland and 12 health visitors from Norway. The results showed more similarities than differences between the Scottish and Norwegian health visitors. Both groups experienced autonomy at work. The hardships of work were the lack of visibility for their work and an inability to demonstrate in measurable ways the effect of their work. Issues related to lack of time and priority of the newborn and young children were also similar as well as the experience of insecurity and strain at work. The differences were mostly within the area of organizational structure and its influence on management matters. While the Norwegian HV participated in plans for the service, employment and budget proposals, the Scottish HV was involved in these matters to a lesser degree. All in all, the similarity of the themes and the comparable units suggest the core of health visiting extends beyond the limits of cultural and national boundaries.

Changes in health visitors' work

AIMS

The purpose of this investigation is to describe Scottish health visitors (HVs) experience of changes in their work and compare these with their Norwegian counterparts.

BACKGROUND

The renewed emphasis on community health care, health promotion and illness prevention is a strong reason to focus on health visiting work. Knowledge about changes in practice are of special interest for nursing science as such knowledge could contribute to the development and advancement of the health visiting service.

DESIGN

The study used a comparative descriptive design. The data are based upon in-depth interviews with nine HVs from Scotland and 12 HVs from Norway.

RESULTS

The results showed similarities as well as differences. HVs in Scotland and Norway experienced changes in work load with decreases in some areas and increases in others, changes in work practice, approaches and techniques with more emphasis on clients' empowerment, and also fewer management positions held by nurses. The differences mainly related to the ways that the health visiting service had specialized and expanded. The aim of Scottish health visiting from 'cradle to grave' service was not adopted by the Norwegian HVs to the same extent. Scottish HVs specialized individually in some areas and used each other's competence to a much greater degree than the Norwegian HVs.

CONCLUSIONS

It appeared that the Scottish HVs had found a path where health visiting work aimed at illness prevention and health promotion for everyone was on the way to becoming a comprehensive service and a stronger and more integrated part of the health visiting service. This is a pathway that Norwegian HVs still have to pursue. The qualitative approach and the slightly different samples limited the possibility for generalizations. Further research should address the question of changes and patterns in health visiting work, of how the development came about, and what are the bases for the differences in specialization and expansion of the service. Secondly it should be asked to what degree the development influences the quality of health visiting and consequences for clients, community and health visiting service.