A Comparison of Braden and Norton Scales Regarding the Risk of Pressure Ulcer Development in a University Hospital

Pressure ulcers are a major health problem and are associated with health care complications and costs. In addition pressure ulcers can cause pain, suffering, infection, decreased quality of life, prolonged hospitalization and even death. The main groups at risk for pressure ulcers include patients with spinal cord injuries, the elderly, hospitalized patients, especially those undergoing orthopedic surgery, and patients admitted to intensive care units. The best way to avoid them is prevention and the most important step in preventing, assessing and identifying of the risk factors for pressure ulcers. Several factors are involved in the formation of pressure ulcers that fall into two categories. Patient-dependent and caring-related factors. There are various risk assessment scales for preventing pressure ulcers that complete the clinical judgment of nurses.This study aimed to determine and compare Braden and Norton instruments to predict the risk of pressure ulcer in hospitalized patients in Amin Hospital of Isfahan University of Medical Sciences in 2018. METHOD:This descriptive cross-sectional study was performed on patients admitted to the intensive care .unit (ICU) and neurology ward of Amin Hospital affiliated to Isfahan University of Medical Sciences in 2018. Based on inclusion criteria, 200 patients during the second half of 2018 were selected by census sampling method and evaluated simultaneously by Braden and Norton scales. Inclusion criteria were lack of pressure ulcer and patient s consent to participate in the study. Exclusion criteria included patient s decision to withdraw from the study, pressure ulcer originated outside the hospital, and other pressure ulcers such as vascular lesions. Patients experiencing pressure ulcers during the study were evaluated and excluded from the follow-up. In this study, the researcher studied patients from admission to discharge for 6 months every day in the morning simultaneously by Braden and Norton scales. Braden is the best scoring system that assesses the risk of developing pressure ulcer in the patient. The tool has six risk assessment criteria that consider the basic dimensions of pressure ulcer (cause and severity of the ulcer, and tissue tolerance to pressure). This is a systematic evaluation and should be performed at the time of admission and ultimately up to 6 hours after admission. Tool domains consisted of sensory perception, skin moisture, activity, mobility, nutrition and friction, and elasticity. Each domain in the Braden scale was scored from 1 (very bad) to 4 (good). Low scores indicate the high risk conditions. Another tool was the standard Norton scale, which examines five separate domains, namely physical condition, mental status, activity, mobility, and incontinence. Each of these is rated from 1 meaning worst condition to 4 meaning most desirable, with a maximum of 20 considered as being the best condition and 16 considered as being at risk. These scales are standard and valid in terms of reliability and validity. In this study demographic questionnaire including sex, age, weight, length of stay, patient care, stage and location of pressure ulcer (if at all) was used. Then Braden and Norton scales were used for evaluation of hospitalized patients. Data were analyzed after measuring normality by descriptive and inferential statistics such as chi-square and SPSS22 and STSTA14 software.FINDINGS: Of the 200 patients studied, 123 (61.5%) were male, with a mean age of 62.16±16.32 years. The mean weight of patients was 32.9±1.66 and hospital stay was 8.36±4.75 days. Among Braden s criteria, three measures of walking ability, limb movement in bed and nutritional status were associated with bed sores (P<0.05). At the Braden scale, score 14 was identified as the best point with a sensitivity of 57% and a specificity of 66% for the risk of pressure ulcer and the Norton scale had a sensitivity of 49% and specificity 61% at the best point. In the Norton scale, 18 patients (9%) had a score higher than 14, with a significant relationship between low score and the incidence of pressure ulcer (P<0.05). There was no significant difference between mean time of wound estimation in two scales (P> 0.05). At Braden scale, there was a significant relationship between age, length of hospitalization and incidence of pressure ulcer and at Norton scale between age and incidence of pressure ulcer (P<0.05).CONCLUSION: Quality of nursing care is one of the key factors in preventing pressure ulcers and it is always important to identify people at risk. Accurate assessment of the patient risk for pressure ulcers with using appropriate tools is the first step in guiding appropriate nursing interventions that prevent pressure ulcers. On the other hand, there is no evidence that using risk assessment measures alone can reduce the incidence of pressure ulcers. According to the results of this study, although there was no significant difference between the two of Braden and Norton scales in mean time of wound estimation, however, finding showed the Braden scale is more effective in pressure ulcer risk prediction than the Norton scale.

Keywords:

Pressure Ulcer , Braden scale , Norton Scales , risk factor , prediction