School of Nursing and Midwifery, Flinders University of South Australia, Adelaide, South Australia, Australia.
Int J Ment Health Nurs. 2013 Aug;22(4):304-12. doi: 10.1111/j.1447-0349.2012.00873.x. Epub 2012 Sep 25.
Absconding from acute psychiatric inpatient units is a significant issue with serious social, economic, and emotional costs. A qualitative study was undertaken to explore the experiences of people (n = 12) who had been held involuntarily under the local mental health act in an Australian inpatient psychiatric unit, and who had absconded (or attempted to abscond) during this time. The aim of the study was to explore why people abscond from psychiatric inpatient units, drawing on published work from health geography on the significance of the person-place encounter, and in particular the concept of 'therapeutic landscapes'. The findings show that the inpatient unit is perceived as a safe or unsafe place, dependent on the dialectical relationship between the physical, individual, social, and symbolic aspects of the unit. Consumers absconded when the unit was perceived as unsafe. Forming a therapeutic relationship with staff, familiarity with the unit, a comfortable environment, and positive experiences with other consumers all supported perceptions that the unit was safe, decreasing the likelihood of absconding. Findings extend existing work on the person-place encounter within psychiatric inpatient units, and bring new knowledge about the reasons why consumers abscond. Implications for practice are discussed.
从急性精神病住院病房擅自离院是一个严重的问题，会带来严重的社会、经济和情感成本。本研究采用定性研究方法，旨在探讨在澳大利亚一家精神病住院病房被非自愿收治且在此期间擅自离院（或企图擅自离院）的 12 名患者的经历，以探索人们擅自离开精神病住院病房的原因。该研究借鉴了健康地理学中关于人与场所相遇的重要性的已发表作品，特别是“治疗性景观”的概念。研究结果表明，住院病房被视为安全或不安全的地方，这取决于病房的物理、个人、社会和符号等方面的辩证关系。当患者认为病房不安全时，他们就会擅自离院。与工作人员建立治疗关系、熟悉病房、舒适的环境以及与其他患者的积极体验，都有助于他们认为病房是安全的，从而降低擅自离院的可能性。研究结果扩展了现有关于精神病住院病房中人与场所相遇的研究，并提供了关于患者擅自离院原因的新知识。文章讨论了对实践的影响。
