Pressure on British health workers to be more explicit in articulating the function, purpose and outcome of their role has increased with the introduction of general management and shift to a market-place orientation, 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 exactly what it is that they do. This has often been portrayed as a major failing, and possibly even a reason to discontinue the service, This paper will offer a potential explanation for this difficulty, and suggest that the management of uncertainty and ambiguity are central to the role, It will draw on a grounded theory study which explored how health visitors choose which approach to use in any particular situation encountered in their work. The analysis suggested that health visiting'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 recognize and respond to complex, potentially risk-filled situations. Drawing on examples which illustrate the implications of these concepts in practice, the paper suggests that, much as midwives have long claimed 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 place. Nevertheless, it will be contended that the particular approach to practice revealed in this study represents a valuable and necessary aspect of health promotion, which has the potential to ensure relevance and acceptability, and which maximizes unexpected opportunities for prevention.
