Epidemiology Scenarios: Injury & Restraints Analysis Report

This assignment presents an analysis of two epidemiology scenarios. The first scenario focuses on traumatic injuries among infants in Buncombe County, North Carolina, exploring data sources like pediatric hospitals, medical journals, and health agencies. The assignment outlines a potential educational intervention targeting caregivers and discusses the projected outcomes. The second scenario addresses the increase in physical and chemical restraints in a hospital setting, identifying risk factors and appropriate data collection methods from patient sheets and pharmacy records. It proposes a Case-Control Study Design, detailing the selection of cases and controls, the computation of Odds Ratios, and strategies to prevent selection and information bias, including complete enumeration and awareness of potential errors in data collection and misclassification.

EPIDEMIOLOGY
SCENARIO 1
Question 1
Data on traumatic injuries especially among infants in Buncombe County, Northern
Carolina can be obtained from pediatric hospitals, medical journals and federal and regional
health agencies. The pediatric hospitals in the area include: Northern Carolina Children’s
Hospital, WakeMed Children’s Hospital and Greenville Pediatrics Service. The American
Journal of Public Health is a reliable source of secondary data. The final source is from two
health agencies: (National Center on Shaken Baby Syndrome, 2018) and (North Carolina
Department of Health and Human Services, 2018).
Question 2
The data that would be gathered from the above sources would help to identify the
hospitals with the highest prevalence of traumatic injuries among infants. These hospitals would
form good sites for an educational intervention.
Question 3
The design for the educational intervention for scenario 1 would follow the same design
in (Kristen, et al., November-December 2011). The intervention would target the caregivers at
the hospital with the highest level of infant traumatic injuries prevalence. The caregivers would
be put into two groups an educational intervention applied for one group.
After a predetermined period, then a structured interview like the one issued in (Kristen,
et al., November-December 2011). Information would also be collected on Age, Experience,
Gender, and Race/Ethnicity. The information from the study would target pediatricians.

EPIDEMIOLOGY
The projected outcome from this study would be that caregivers in the group where
educational intervention was applied would be more aware of the existence of Shaken Baby
Syndrome and ways of avoiding of preventing the infant traumatic injuries. This is in
comparison to caregivers in the group where educational intervention was not applied.

EPIDEMIOLOGY
SCENARIO 2
Question One
In accessing the situation in scenario 2, I would identify all the risk factors that would
lead to the increase in the number of physical restraints and chemical restraints in the form of
sedating medication. This would exclude factors such as staff acuity, patient mix and staffing
which have remained unchanged during the period of increase in this cases.
I would then observe the patients that have had to be restraint, through physical or
chemical means, as well as those that have not been restrained with regards to the risk factors
that I identified.
Question Two
The data for supporting the concerns about increase in in the number of physical
restraints and chemical restraints in the hospital can be collected from two sources. The sources
are categorized depending on the nature of restraints used.
In the case of the physical restraints, data would be collected from the patient sheet for
nurses. These patient sheet would indicate as to whether the nurse had to use physical restraints
for the particular patient and also what exactly prompted the nurse to do so.
In the case of the chemical restraints, data would be collected from the hospital pharmacy
records. From these records, we can establish which patients are restrained using sedating
medication as well as their number. We can also find out when the chemical restraints started for
a patient.

EPIDEMIOLOGY
Question Three
The most appropriate study design for the situation presented in scenario 2 would be a
Case-Control Study Design. This is a study design where the population with the condition of
interest is first identified (case), then the investigator identifies a population without the
condition (control). Once the case and control groups have been identified, then the risk factor is
observed for both groups for comparison and analysis (Ann & Patty, 2016).
In the situation presented in this scenario, we will first identify the patients that have
been physically or chemically restrained, they will form the cases. Then we will identify the
patients that have not been physically or chemically restrained, they will form the controls. Then
for every risk factor identified in Question 1 above, a 2 x 2 table will be obtained to observe and
the Odds Ratio computed. The Odds Ratios for the risk factors can then be compared to
determine the risk factor causing the situation in this scenario.
Question Four
In order to prevent the occurrence of selection bias error in the sample selection process
as well as to increase the probability of an accurate analysis, I would carry out a complete
enumeration. All the patients in the hospital will be part of the population of study.
Question Five
The control group for our study will be the patients in the hospital that have not been
restrained for the period of observation and study.

EPIDEMIOLOGY
Question Six
Information bias would be the main error in our study. This is a systematic error that
occurs during the data collection process including the sources of the data (Ann & Patty, 2016).
In our case, the information recorded in the patient sheet for nurses or the pharmacy records may
be inaccurate or incomplete.
Misclassification bias may also affect the study. This is a systematic error that occurs
when a case is indicated as a control or a control as a case (Ann & Patty, 2016). This mix up may
happen during the recording of the cases and controls in our study.

EPIDEMIOLOGY
References
Ann, C. C., & Patty, V. A. (2016). Population-Based Nursing [Electronic Resource]: Cocepts
and Competencies for Advanced Practice 2nd Edition . New York: Springer Publishing
Company .
Kristen, B., Kim, L., Kimberly, D. M., Niyati, S., Leventhal, J. M., & Colson, E. (November-
December 2011). Impact of Educational Intervention on Cargivers' Beliefs About Infant
Crying and Knowledge of Shaken Baby Syndrome. Academic Pediatrics, 481-486. 11(6).
National Center on Shaken Baby Syndrome. (2018, January). north-carolina. Retrieved from
dontshake: www.dontshake.org
North Carolina Department of Health and Human Services. (2018, January). NCDHHS.
Retrieved from NCDHHS: www.ncdhhs.com