• family nurse;
  • grounded theory;
  • health visiting;
  • preventative family health care;
  • public health nursing;
  • role identity

machin a.i., machin t. & pearson p. (2012) Maintaining equilibrium in professional role identity: a grounded theory study of health visitors’ perceptions of their changing professional practice context. Journal of Advanced Nursing68(7), 1526–1537.


Aims.  This article reports the study of a group of United Kingdom health visitors’ interactions with their changing practice context, focusing on role identity and influences on its stability.

Background.  United Kingdom policies have urged health visitors to refocus their role as key public health nurses. Reduced role identity clarity precipitated the emergence of different models of health visiting public health work. An inconsistent role standard can lead to role identity fragmentation and conflict across a group. It may precipitate individual role crisis, affecting optimum role performance.

Methods.  Seventeen health visitors in two United Kingdom community healthcare organizations participated in a grounded theory study, incorporating constant comparative analysis. Direct observations and individual interviews were undertaken between 2002 and 2008.

Results/findings.  Four interlinked categories emerged: professional role identity (core category); professional role in action; interprofessional working; and local micro-systems for practice; each influencing participants’ sense of identity and self-worth. The Role Identity Equilibrium Process explains interactive processes occurring at different levels of participants’ practice.

Conclusion.  Re-establishing equilibrium and consistency in health visiting identity is a priority. This study’s findings have significance for other nurses and health professionals working in complex systems, affected by role change and challenges to role identity.