Difficult work: health visitors' work with clients in the community.

The purpose of this paper is to discuss health visitors' construction of difficult work as uncovered in their descriptions of actual cases. The grounded theory approach was used to uncover the processes by which health visitors work with clients in the community. Forty-five experienced health visitors participated in the research. Data were collected using semi-structured, conversational interviews, field notes, and a short data collection form. Findings identified three types of situations in their work which created difficulty for health visitors: concerns about client safety, inappropriate use of health visitor services, and client denial and blocking. Several approaches to dealing with difficult situations were identified. These were labelled as: "more of the same", "wait for a bit", "withdrawal", "fall back on routine visiting", "try something else", and "open up the problem situation/confrontation". The use of approaches was related to factors in the context in the situation in which the health visitor found herself, and factors related to the health visitor and her particular style of practice. This paper assists in understanding how health visitors work with clients in the community to influence health.