Questioning the Quality of Maternal Caregiving During Home Visiting

Purpose: To formulate theory that will provide a meaningful framework for practice and for studies examining the efficacy of maternal‐child home visits. Design: Field research, over a period of 8 months, 1995–1996, conducted with one nurse employed by a visiting nurse association in rural New England. A total of 53 home visits were observed; documents and records were reviewed. Methods: Data collection, field‐note recording, and analysis were simultaneous. Informal interviewing and observation of the key nurse participant throughout the day focused on her intentions, actions, and meanings as she anticipated, enacted, or reflected on her visits. Client‐nurse interaction and client characteristics were described and interpreted. Analysis focused on the nurse's home visits and the consequences of these visits. Findings: The nurse conducted a specific type of home visit, identified as “child‐focused,” in three patterns: single, short‐, and long‐term. The short‐term pattern, labeled “questioning the quality of maternal caregiving,” is described in this article. The nurse minimally questioned and then confirmed the quality of maternal caregiving during some visits, while she seriously questioned and then continuously doubted the quality of caregiving in others. The categories of potential consequences of these visits were maternal, child, interactive, and environmental. Conclusions: Future research should address the most effective processes for working with families when nurses doubt the quality of maternal caregiving. Field research was helpful in developing a beginning typology of maternal‐child home visits, in understanding practice, and as a basis for further research examining the efficacy of maternal‐child home visits.