Improving communication with patients in post-traumatic amnesia: development and impact of a clinical protocol. (18th September 2020)

• Record Type: Journal Article
• Authors: Hart, Tessa; Ferraro, Mary; Rabinowitz, Amanda; Fitzpatrick DeSalme, Eileen; Nelson, Lauren; Marcy, Elizabeth; Farm, Stephanie; Turkstra, Lyn
• Is Part Of: Brain injury. Volume 34:Number 11(2020)
• Page Start: 1518
• Page End: 1524
• Publication Date: 2020-09-18
• Subjects: Brain injuries -- post-traumatic amnesia -- post-traumatic confusion -- clinical guidelines; Brain damage -- Periodicals; Brain -- Wounds and injuries -- Periodicals; Brain Injuries -- Periodicals; 617.481
• DOI: 10.1080/02699052.2020.1809710
• Languages: English
• ISSNs: 0269-9052

Abstract

ABSTRACT: Objective: To assess the impact of staff training focused on improved treatment and communication with patients in post-traumatic amnesia (PTA) or other disorders of explicit (declarative) memory. A major aim was to minimize questions demanding recall from explicit memory, e.g., orientation quizzing, and personal/medical history questions, which may produce unreliable information and exacerbate patient frustration and anxiety. Methods: Mixed-methods design. Inpatients with impairments of explicit memory were observed before (n = 4) and after (n = 4) training, with staff interactions recorded verbatim. Records were coded for types of questions and patient responses. Clinicians who worked before and after training were surveyed regarding perceived changes in practice, team functioning, and patient behavior. Results: Explicit memory questions decreased significantly, as did irrelevant or "don't know" responses from patients, with large nonparametric effect sizes noted. The frequency of questions not relying on explicit memory remained stable. Most clinicians reported positive effects on their own and others' practice with memory impaired patients, and one-quarter noted less patient frustration or agitation. Conclusions: Although questioning patients is a natural part of medical care, targeted staff training can result in positive changes in communication practice and should be considered for facilities treating patients in PTA.