title: 'It is a dilemma': perspectives of nurse practitioners on health screening of newly arrived migrants.
abstract: BACKGROUND
  Screening newly arrived migrants from countries with high burden of communicable diseases of public health significance is part of the Swedish national strategy against the spread of these diseases. However, little is known about its implementation.
  
  
  OBJECTIVE
  This study aimed at exploring caregivers' experiences in screening newly arrived migrants to generate knowledge that could inform policy and clinical practice.
  
  
  METHODS
  Using an interpretive description framework, we conducted semistructured interviews between November and December 2011 in four Swedish counties, with 15 purposively selected nurses with experience in screening migrants. Data were analyzed using thematic analysis.
  
  
  RESULTS
  Participants described a range of challenges including discordant views between migrants and the nurses about medical screening, inconsistencies in rules and practices, and conflicting policies. Participants indicated that sociocultural differences resulted in divergent expectations with migrants viewing the participants as agents of migration authorities. They also expressed concern over being given a new assignment without training and being expected to share responsibilities with staff from other agencies without adequate coordination. Finally, they indicated that existing policies can be confusing and raise ethical issues. All these were compounded by language barriers, making their work environment extremely complex and stressful.
  
  
  CONCLUSIONS
  These findings illuminate complex challenges that could limit access to, uptake, and delivery of health screening and undermine public health goals, and highlight the need for a multilevel approach. This entails avoiding the conflation of migration with health issues, harmonizing existing policies to make health care services more accessible and acceptable to migrants, and facilitating health professionals' work in promoting public health, improving interagency collaboration and the skills of all staff involved in understanding and effectively responding to migrants' needs, and improving migrants' health literacy through community outreach interventions.
authors.affiliation: Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden; faustine.nkulu@epiph.umu.se.
authors.forename: Faustine K Nkulu
authors.initials: FK
authors.lastname: Kalengayi
authors.affiliation: Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Hurtig
authors.affiliation: Public Health Center, Norbotten County Council, Luleå, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Nordstrand
authors.affiliation: Department of Clinical Microbiology, Division of Infectious Diseases, Umeå University, Umeå, Sweden.
authors.forename: Clas
authors.initials: C
authors.lastname: Ahlm
authors.affiliation: Department of Women's and Child Health, Uppsala University, Uppsala, Sweden.|Skaraborg Institute for Research and Development, Skövde, Sweden.
authors.forename: Beth M
authors.initials: BM
authors.lastname: Ahlberg
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003144:Communication Barriers; D003299:Cooperative Behavior; D003466:Cultural Characteristics; D054521:Cultural Competency; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D008403:Mass Screening / Q000458:organization & administration* / Q000523:psychology; D009722:Nurse Practitioners / Q000523:psychology*; D010465:Perception; D012959:Socioeconomic Factors; D013548:Sweden; D014171:Transients and Migrants
keywords: Sweden; cultural competence; health policies; interpretive description; language barriers; migrants; migration policy; nurses; screening; thematic analysis