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Seeking freedom: a systematic review and thematic synthesis of the literature on patients' experience of absconding from hospital.

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 associate with absconding is best characterised 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.