Braden Scale risk assessments and pressure ulcer prevention planning: what's the connection?

Objective: To investigate the relationship between risk assessment scores on Braden subscales and nurses' selection of 10 commonly used best-practice pressure ulcer (PU) preventive interventions.

Design: Exploratory secondary data analysis, using a descriptive correlational design.

Setting And Subjects: A total of 377 Braden Scale PU risk assessments were made on 102 patients at different levels of risk. Assessments were made by RNs working at 3 different acute care hospitals. RNs making risk assessments also used an intervention checklist to select from 10 commonly used preventive interventions that should be implemented based on patient level of risk on each Braden subscale.

Instruments: The Braden Scale for Predicting Pressure Sore Risk was used to guide risk assessments. The Registered Nurses Intervention Checklist was used to identify PU preventive interventions that should be implemented.

Results: Braden subscale ratings influenced nurses' endorsement of preventive interventions in 2 distinct ways. First, endorsement of most (9 out of 10) preventive interventions was influenced by risk information embedded in unique combinations of Braden subscale assessments. Second, there appears to be a predictable pattern of increase in the likelihood of endorsing an intervention as Braden subscale scores decreased and the level of risk increased.

Conclusion: Variability in Braden subscale ratings differentially predicts nurses' endorsements of selected PU-prevention interventions. Also, there is a predictable pattern of increase in the likelihood of endorsing a preventive intervention as PU risk levels increase, a pattern that may be related to the timing of risk assessment and PU-prevention planning activities.