Biomedical subjects

F Kiyimba

Publications and source records attributed to F Kiyimba.

5 recordsLinked to original sources

PubMed2000

Determinants of absconding by patients on acute psychiatric wards.

Determinants of absconding by patients on acute psychiatric wards Absconding by patients from acute psychiatric wards is a high risk behaviour and has been linked to harm to self and others. Previous research on the characteristics of absconders has been overly reliant on officially generated statistics and small numbers of variables, limiting the conclusions that may be drawn. This paper reports on a prospective study of absconders from 12 acute admission wards in three English National Health Service Trusts over 5 months, compared to a control group matched for ward. Extensive data on absconder and control characteristics were collected from case records and from nursing staff. Absconders were significantly different from controls in many respects. Absconding is linked to other forms of non-compliant patient behaviour, e.g. medication refusal and involvement in violent incidents. Significant variations in the rates of absconding were found between different wards, and between different consultant psychiatrists. Predictive factors were identified by logistic regression. Study in the diverse fields of non-compliance should be brought together as these phenomena are likely to be interrelated. Further investigation is required to determine exactly what it is that consultant psychiatrists and ward nurses do that affects absconding rates.

Acute Disease↗

PubMed1999

Absconding: why patients leave.

Absconding by patients from acute psychiatric care poses a significant problem to professional staff, and can involve significant risks for patients and others. This paper describes the methodology of a major prospective study of absconding recently completed in the East End of London, and reports the findings on why patients abscond from hospital. Interviews with 52 patients who returned to their wards showed that they abscond because they are bored, frightened of other patients, feel trapped and confined, have household responsibilities they feel they must fulfil, feel cut off from relatives and friends, or are worried about the security of their home and property. Psychiatric symptoms also contribute to the decision to leave, but in nearly every case patients can give additional and rational reasons for their abscond. Some patients leave impulsively and in anger following unwelcome news about delayed permission for leave or discharge. Others leave specifically in order to carry out some activity outside the hospital. In order to reduce absconding and rejection of care, nurses may need to carefully consider the meaning admission has for patients, and the impact it can have upon their everyday lives.

Escape Reaction↗

PubMed1999

Absconding: how and when patients leave the ward.

Information about how and when patients abscond from acute psychiatric wards may provide important clues to effective prevention strategies. This paper reports relevant findings from a large scale study of absconding conducted in the East End of London. In contrast to the findings in previous studies, the vast majority of absconders left from the ward directly, mostly via the front door. Some were known to be at risk of absconding, and although more than half had declared their intention to leave, they still succeeded in getting away. On some occasions they circumvented locked or guarded doors, or special nursing observation. Shift handovers were a peak time for absconds, possibly due to decreased nursing surveillance of the ward. Most absconds occur during the first few weeks of admission, and most absconders simply went home and engaged in normal, everyday activities. The findings indicate that physical security measures alone are not a sufficient answer to the problem of absconding, and nurses need to work harder to develop supportive alliances with patients.

Escape Reaction↗

PubMed1999

Absconding: outcome and risk.

Absconding by patients from acute psychiatric wards is known to be linked to self harm and harm to others. Previous research has focused only on officially reported absconds, thus missing out many patients who although they abscond and pose a risk, are never officially processed. This paper reports the findings of a large prospective study of absconding in the East End of London using an objective definition of absconding not linked to official bureaucratic processes. Absconders are considered by staff to be high risk patients, and many have histories of violence and/or suicide attempts. Nevertheless nurses only request the aid of the police in returning patients on 47% of occasions. The actions of the police are very variable, and range from two policemen calling at the patient's house, to an entire team in riot gear appearing at the patient's door in the early hours of the morning. Most absconds result in no harm to anyone, and most absconders return by themselves. Relatives and carers also play a significant role in persuading the patient to return or bringing them back. Nurses should develop more sophisticated ways of working with the police and with relatives to maintain absconding patients' safety.

Escape Reaction↗

PubMed1999

Absconding: nurses views and reactions.

Absconding from acute psychiatric wards is common. This paper reports the views of 25 staff nurses working on acute mental health wards in East London about absconding. Interviews explored how staff feel when a patient absconds, the complexities of risk assessment and observation policies, who is blamed when patients abscond and what might reduce absconding. The assessment of the level of risk which a patient posed varied considerably, with some wards using standard risk assessment tools and others talking about their own methods. There was some evidence of conflict with medical staff about what measures should be put in place to manage the risk (observation level, leave). The interviewees were aware of serious consequences of absconding, and this made them worry when patients absconded. Following an abscond most nurses look for an explanation, and this can lead to blame of other members of the team. A sizeable minority spoke of feeling unsupported by their managers, and that their jobs could be at risk following an abscond. The nurses felt that absconding could be reduced through a number of measures, principally raising staffing levels and reducing the reliance on agency nurses.

Attitude of Health Personnel↗