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OPPORTUNITIES AND BURDENS FOR NURSE-MIDWIVES WORKING IN PRIMARY HEALTH CARE: An Example From Population-Based Cervical Cancer Screening in Urban Sweden


  • Jeanne Raisler CNM, DrPH,

  • Catarina Widmark RN, RM,

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    • Catarina Widmark is a nurse-midwife educated in Britain, currently conducting research on a variety of issues related to women's health at the Department of Nursing and the Department of Public Health Sciences, Karolinska Institute. She holds a position as midwife at Huddinge University Hospital, Sweden.

  • Carol Tishelman RN, DrMedSc,

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    • Carol Tishelman, RN, PhD has a postdoctoral fellowship at Karolinska Institute and is employed as researcher and senior lecturer at the Department of Nursing and the Department of Public Health Sciences, Karolinska Institute. Her research focus is on lay and professional interpretation of cancer prevention and symptom experiences.

  • Eva-Lisa Lundgren RN, MA,

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    • Eva-Lisa Lundgren, RN, MA, is director for postgraduate education for clinical nursing specialities at the Department of Nursing, Karolinska Institute and is a graduate student within the project described in this article.

  • Anette Forss RN, BA,

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    • Anette Forss, RN, BA, is presently a master's student in social anthropology at Stockholm University, and a research assistant at Karolinska Institute. She works as an RN at the Department of Infectious Diseases, Danderyd Hospital, Sweden.

  • Lisbeth Sachs PhD,

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    • Lisbeth Sachs is an associate professor in social anthropology and Acting Professor at the Department of Communication Studies, Linköping University and a researcher at Karolinska Institute in the field of medical anthropology.

  • Sven Törnberg MD, DrMedSc

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    • Sven Törnberg, MD, is an associate professor in oncology, and head of the cancer screening unit at the Oncologic Centre in Stockholm. He is responsible for calling, follow-up and evaluation of the population-based cervical cancer screening program.

  • Midwives in Sweden must be registered nurses prior to becoming midwives. We, therefore, use the terms nurse-midwife and midwife interchangeably in this article.

Catarina Widmark, RN, RM, Department of Public Health Sciences, Division of International Health Care Research (IHCAR), Karolinska Institute, Se- 171 76 Stockholm, Sweden.


In Sweden, nurse-midwives in primary health care are responsible for taking Papanicolaou smears in population-based cervical cancer screening programs. This article discusses the manner in which a group of nurse-midwives, working with the cervical cancer screening program, view both opportunities and burdens inherent in their work. Semistructured interviews were conducted with 21 nurse-midwives engaged in screening at seven antenatal health care centers in demographically different parts of Stockholm, using a team approach to collect and inductively analyze the interviews. Results indicate discrepancies between ideals guiding the midwives and their practice. Positive aspects described by the midwives appear to be related to an ideology of care, whereas perceived burdens include the midwives' sense of powerlessness, lack of congruence between midwives' ideology and screening organization, and lack of professional familiarity with cancer. Several of these features can be related to issues that are challenges for many health care practitioners today, even in other settings. Our conclusion is that the screening program has latent potential for further development of the role of the nurse-midwife as an advocate for women throughout the lifespan and in a variety of situations.