Improving communication with patients in post-traumatic amnesia: development and impact of a clinical protocol

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.

KEYWORDS:

• Brain injuries
• post-traumatic amnesia
• post-traumatic confusion
• clinical guidelines

Acknowledgments

The authors thank the following members of the PTA Protocol work group for their contributions to the project described in this paper: Lisa Jennings, RN, Nicole Bongart, RN, and Deborah Presutti, MA, CCC-SLP.

Declaration of interest

The contents of this manuscript were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), grant number 90DPTB0004. NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research [90DPTB0004].