South West London and St George's Mental Health NHS Trust, London, UK.
University of Southampton, Hampshire, UK.
J Psychiatr Ment Health Nurs. 2019 Nov;26(9-10):289-300. doi: 10.1111/jpm.12551. Epub 2019 Aug 23.
WHAT IS KNOWN ON THE SUBJECT?: Absconding refers to patients leaving psychiatric hospitals in an unexpected and/or unauthorized way and is often recognized as a form of challenging behaviour. There is some research about the rates of absconding, risks associated with it and interventions to try and reduce it; however, relatively little is known about the experience from the perspective of patients and this evidence has not previously been systematically reviewed. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Patients abscond to find relief, to regain power and control over their lives and/or to address unmet needs. Absconding can therefore be viewed as a means of seeking freedom. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses need to be aware that absconding is a positive act from the patient perspective and work collaboratively with them to reduce factors which motivate this behaviour. From the point of admission, nurses have an important role to play in reducing the sense of fear, isolation and powerlessness which motivates patients to abscond. Practical interventions such as giving patients the time and information necessary to be involved in decision-making, or asking about their responsibilities and commitments outside of hospital, may have a significant impact on the experience of admission and reduce the risk of absconding. Abstract Introduction Absconding from psychiatric hospitals is associated with significant risks, but is difficult to assess. It is often considered a form of challenging behaviour for mental health nurses, yet there is little evidence considering the behaviour from the patient perspective. Aim To identify and review evidence pertaining to the experience of patients who abscond from hospital, paying particular attention to their reasons for doing so. Method A systematic review and thematic synthesis of eight peer-reviewed studies. Results The meaning patients associated with absconding is best characterized as an act of seeking freedom. Within this, four sub-themes were identified: 1) seeking freedom to find relief, 2) to regain power and control over their lives, 3) to address unmet needs and 4) opportunistically. Discussion Perspectives on absconding are markedly different between nurses and patients. Nurses may view absconding as challenging or deviant behaviour, whilst patients understand it as a positive experience. This is because the hospital environment is not meeting their needs. Implications for practice Patients decide to abscond from hospital for valid and rational reasons. Mental health nurses are in a position to understand and address the issues underpinning them with a view to reducing absconding. Further research on absconding from hospital, taking the patient's perspective, is needed.
擅自离院是指患者以意外和/或未经授权的方式离开精神病院，通常被认为是一种挑战行为。虽然已经有一些关于擅自离院率、相关风险以及试图减少擅自离院的干预措施的研究，但关于患者体验的相关知识相对较少，而且这些证据以前没有经过系统的审查。本研究增加了哪些新的知识：患者擅自离院是为了寻求解脱，重新获得对生活的掌控和权力，或满足未得到满足的需求。因此，擅自离院可以被视为寻求自由的一种方式。这对实践有哪些影响：护士需要意识到，从患者的角度来看，擅自离院是一种积极的行为，并与他们合作，减少促使他们这样做的因素。从入院开始，护士在减少促使患者擅自离院的恐惧、孤立和无力感方面发挥着重要作用。给予患者必要的时间和信息来参与决策，或询问他们在院外的责任和承诺等实际干预措施，可能会对入院体验产生重大影响，并降低擅自离院的风险。
摘要 介绍：从精神病院擅自离院与重大风险相关，但难以评估。这通常被认为是精神科护士面临的一种挑战行为，但很少有证据从患者的角度考虑这种行为。 目的：确定并审查与从医院擅自离院的患者相关的证据，特别关注他们这样做的原因。 方法：对八篇同行评审的研究进行系统回顾和主题综合。 结果：患者与擅自离院相关的意义最好被描述为寻求自由的行为。在此基础上，确定了四个子主题：1）寻求解脱的自由，2）重新获得对生活的掌控和权力，3）满足未满足的需求，以及 4）偶然。 讨论：护士和患者对擅自离院的看法明显不同。护士可能会将擅自离院视为挑战或异常行为，而患者则将其理解为一种积极的体验。这是因为医院环境不能满足他们的需求。 对实践的影响：患者擅自离院是出于合理和合理的原因。精神科护士有能力理解和解决潜在问题，以减少擅自离院的发生。需要进一步从患者的角度研究从医院擅自离院的问题。
