Absconding from a psychiatric setting in Indonesia: a case study

Nurjannah, Intansari (2007) Absconding from a psychiatric setting in Indonesia: a case study. Masters (Research) thesis, James Cook University.

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Patients absconding from psychiatric settings are a phenomenon that has increasingly caught the attention of nursing researchers in Western countries. This phenomenon also occurs in psychiatric hospitals in Indonesia. However, this is not a topic that has received a great deal of attention in terms of research in Indonesia.

The aim of the study is to provide a profile of absconding events over a one-year period in one psychiatric setting. The objectives of the study are to:

• identify demographic patterns associated with all patients who abscond from one psychiatric hospital during a one-year period;

• describe the experience of patients and nurses related to incidents of absconding;

• identify the contextual factors that promote and obstruct absconding behaviour; and

• discuss the ways in which absconding events in this case differ or are similar to reports of absconding in the West.

A case study using mixed methods and concurrent triangulation has been undertaken in order to provide a profile of absconding events over a period of one year in a psychiatric hospital in Indonesia. Data included a one-year audit of absconding events, a period of observation, and interviews with patients and nurses.

Over a one-year period of data collection 133 absconding events were recorded that involved 106 patients. The predominant pattern of people who abscond is that they are young male patients with a history of previous admission. 70% of patients return to the hospital on the day of absconding. On the face of it, this information is consistent with findings in the West, however qualitative data reveals significant differences.

Sixteen patients who absconded during a seven-month period of data collection were interviewed. Three themes were identified: ‘The call to home’, ‘Hopes and realities’ and ‘Us and them’. All these themes link to the process of recovery. ‘The call to home’ and hopes for happier life are considered as the first step in the process of recovery. ‘The call to home’ reflected the patients’ eagerness to have connection with their family and to feel safe. Patients hope to experience a happier life, however most of their hopes are dashed as they fail to reach home or their family sent them back to hospital. The last theme is ‘Us and them’ in which the patients describe the differences between them and others, and the consequence of the differences which create negative feelings and forms a barrier to developing and growing towards recovery.

Observations and interviews with 24 nurses reveal a style of nursing that is custodial rather than therapeutic. The days are filled with routine duties, and opportunities to prepare patients for discharge as an important part of the recovery process, are missed. The nursing staff is disappointed with the attitude of the family and community towards people with mental health problems and believes that families are responsible for patients once they are ready for discharge.

The majority of patients who absconded from the hospital in this study were ready for discharge and awaiting collection by their family. They were considered to be in the process of recovery, but it appears that there is little adequate support for patients who are ready to be discharged from hospital. It is not unusual for patients who have absconded to be brought back to hospital again by their family if they are not well received in the community.

Short term recommendations centre on the rehabilitation focus and activities in the hospital. Nurses should become more involved with interventions that are appropriate in rehabilitation processes and see it as an integral part of discharge planning included in management plans. In the longer term, nurses require resources to support their education and the implementation and evaluation of person-centered models of care. Strategic plans should be implemented to change public and professional attitudes towards people with a mental health problem. Further research on this topic is required to understand family and community attitudes, recovery from a range of perspectives and test alternative models of nursing care.

Item ID: 2132
Item Type: Thesis (Masters (Research))
Keywords: psychiatric institutions, hospitals, Indonesia, patients, mentally ill, characteristics, absconding, nursing, nurses, services, attitudes
Date Deposited: 14 Jul 2009 01:25
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110319 Psychiatry (incl Psychotherapy) @ 40%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111718 Residential Client Care @ 30%
11 MEDICAL AND HEALTH SCIENCES > 1110 Nursing > 111005 Mental Health Nursing @ 30%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920410 Mental Health @ 100%
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