Sammanfattning av publikation

Gullberg & Whilborg, 2014 đź”—

Nurses’ experiences of encountering undocumented migrants in Swedish emergency healthcare

Year: 2014

Type of text: Academic article

Published by:  International Journal of Migration, Health and Social Care.

Language: English

Author: Frida Gullberg & Monne Wihlborg

Pages: 11

Available at:
[Inte offentligt tillgänglig, abstract tillgängligt via länk]

“At the time of the study, access to health care for undocumented migrants in Sweden was regulated by The Act on Health Care for Asylum Seekers and Others (Government Office of Sweden, 2008 (Lagr˚adsremiss); see also Bjo ¨rngren Cuadra, 2010). The Act includes hidden children (rejected asylum-seeking children) under the age of 18 but excludes adult undocumented migrants and undocumented children who have not previously applied for asylum.” (149)

“Since the study was conducted, concerns voiced about inadequacies inthe system resulted ina new national law, Health care for individuals residing in Sweden without permission, which was enacted July 1, 2013. This law obliges county councils to give undocumented migrants access to health care on equal terms as asylum seekers (Ministry of Health and Social Affairs, 2012 (Socialdepartementet)). While extending state subsidies and the categories of care that may be offered to undocumented migrants is certainly a welcome development, most of the problems and tensions expressed by the nurses in the study subsist.” (155)

Short description of text 

“The purpose of this paper is to investigate how nurses’ working in emergency health care in Sweden experience their encounter with undocumented migrants.“ (148)

Most important results

“The process of assessment involves formal regulations as well as interpersonal features, leading to uncertainty, conflicts and dilemmas when judging such situations. Nurses’ conceptions concerned the undocumented migrants’ migrant status and social existence; second, conflicts in encountering undocumentedness pertaining to an identification systems and judgments and emotional reactions; and thrid, shifts within and between arbitrary boundaries, with unclear conditions for interaction and creative maneuvering. “ (148)

“First, in Sweden, nurses generally make the first medical assessments in emergency services. They therefore become important actors, as a filter and interpreter in guiding subsequent care for the patient (Cioffi, 2003; International Council of Nurses, 2012; Månsson, 2012; Varcoe et al., 2004). (149)

“The differences between and within categories[2] of migrant status were experienced as confusing, vague and subtle.” (151)

“Nurses saw the undocumented migrant as having a “degraded” existence and expressed concerns regarding deterioration in the migrant’s mental and physical health, caused by the challenges of living in Sweden without legal status. The undocumented migrant lost weight, changed her physical appearance or facial expression, lost energy in the eyes, had graying hair. A few nurses, who had first met the migrants as asylum-seekers and later as undocumented migrants, observed a gradual deterioration first, in the migrant’s mental and emotional condition and second, as well as negative changes in personality similar to symptoms caused by other forms of trauma and stress” (152)

“Identification system. The nurses had to register the undocumented patient as “unidentified” when no identification document was present. In such cases, the absence of a medical record reduced available information. The staff had to rely entirely on the patient’s statement without reference to earlier assessments or diagnosis. Registering the person as “unidentified” prevented blood tests from being analyzed, because the laboratory’s computer system could not read the unidentified number. X-ray files or electrocardiograms could not be saved in the medical journal. Electronic prescriptions for medication could not be written. This could present minor difficulties for nurses as physicians were reluctant to produce handwritten prescriptions, since these were restricted by Pharmacy regulations.” (152)

“Unclear conditions for interaction. To be able to assess the medical status of the undocumented migrant and take appropriate measures, the nurses had to relate to relevant policy and guidelines for emergency care for this specific patient group, as well as estimating costs for care and making ethical judgments. Policy concepts (“immediate care”, “care that cannot be deferred” and “immediate necessary care”) were described as vague, without clear meaning or boundaries for application, resulting in arbitrary assessments and treatments. According to the nurses’ interpretations, the concepts entailed anything from urgent emergency care where in-patient treatment was needed to check-ups of chronic diseases lying under the responsibility ofprimary healthcare.The aspect “costsfor medical care” compriseddescriptions of how undocumented migrants would burden the clinic’s economy, because the patients lacked insurance coverage and subsidized medical equipment and rehabilitation could not be claimed. In some cases, pre-payment of the full fee was demanded in cash, in accordance with rules for foreigners” (153)

Theoretical perspective/framework


16 kvalitativa intervjuer i södra Sverige med sjuksköterskor inom akutsjukvård

“Time ranged between 30 and 70minutes. In total, 11 women (four between 20 and 40 years, four between 40 and 60 years, three over 60 years) and five men (four between 20 and 40 years, one between 40 and 60 years) were interviewed. The nurses worked at different emergency units and primary health care receptions. Five nurses were placed at the psychiatric emergency unit, three at the women’s emergency unit, two at the delivery unit, two at the major emergency unit, two at a primary health unit, and the final two at a Non-Governmental Organization.” (150)

Policy suggestions

“The ethical core of medicine should be focused more explicitly, i.e. the responsibility to give care according to need and not according to the patient’s citizenship status or ability to pay.” (155)

“Also, findings suggest that better education regarding health care policy for undocumented migrants is called for, as well as continuous ethical reflections and discussions among co-workers regarding the marginalized undocumented patient.” (155)

Suggestions for further research

“Further research is needed to develop guidelines or other structures to support nurses who deal with this kind of assessment in their daily work, to reduce ethical dilemmas and the risk of inequitable treatment.” (148)

Summarised by: Josefin Åström