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.

中文翻译：

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在创伤后遗忘症中改善与患者的沟通：临床规程的发展和影响

目的

评估工作人员培训对改善创伤后遗忘症（PTA）或其他显性（陈述性）记忆障碍患者的治疗和与患者沟通的影响。一个主要目的是最大程度地减少要求从显式记忆中回忆的问题，例如定向测验和个人/病史问题，这些问题可能会产生不可靠的信息并加剧患者的沮丧和焦虑感。

方法

混合方法设计。在训练前（n = 4）和训练后（n = 4）观察到显性记忆障碍的住院患者，并逐字记录员工的互动情况。记录编码为问题类型和患者反应。调查了在训练前后工作的临床医生有关实践，团队功能和患者行为方面的感知变化。

结果

显式记忆问题显着减少，患者的无关或“不知道”反应也显着减少，并且注意到较大的非参数效应量。不依赖显式记忆的问题频率保持稳定。大多数临床医生报告说，对于记忆力受损的患者，他们自己和其他人的做法都会产生积极的影响，四分之一的人注意到患者的挫败感或激动感减少了。

结论

尽管向患者询问是医疗服务的自然组成部分，但有针对性的员工培训可能会导致沟通实践发生积极变化，应考虑将其用于治疗PTA的患者。