Wednesday, September 26, 2007

Pssstt.. jangan bilang pasien 'kabur' tapi...

--a-b-s-c-o-n-d-i-n-g--- itu jawabannya menurut Master kita Intansari Nurjannah di Exit Seminarnya.. berikut abstract-nya..

Title: Patient absconding from a psychiatric setting in Indonesia: a case study

Intansari Nurjannah*
Mary FitzGerald**
Kim Foster***

Absconding from mental health services is 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 mental health institution. The objectives of the study are to:

identify demographic patterns associated with all absconders from the Institution 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 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 patterns of people who abscond are young male patients with a history of previous admission. Most patients return to the hospital on the day of absconding. This information is consistent with findings in the West.

Sixteen patients who absconded during a seven months 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 hoped for happier life considered as the first step for recovery process. ‘The call to home’ was the result of patient’s eagerness to have connection with their community and to feel safe. Patients hoped to experiences a happier life however most of their hopes are dashed as they failed to reach home or their family sent them back to hospital. The last theme was ‘Us and them’ in which the patients describe the differences between them and others and the consequence of the differences which form a barrier for developing and growing to be recover and also creates negative feelings.

Observations and interviews with 24 nurses revealed 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 important part of recovery process are missed. The nursing staffs are disappointed with the attitude of the community to people with mental health problems and believe 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 as they were considered to be in the process of recovery. 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. 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 attitude towards people with a mental health problem. Further research on this topic is required to understand community attitudes and test alternative models of nursing care.


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