The Braden Scale

Evidence suggests that pressure ulcers greatly increase mortality rates in both hospitals and nursing homes (Thomas, 2001). Patients who develop a pressure ulcer within six weeks of admission to an acute-care facility are three times more likely to die than patients who do not develop pressure ulcers (Thomas, 2001). Moreover, patients who develop a pressure ulcer within three months of admission to a long-term care facility are associated with a 92% mortality rate compared with a 4% mortality rate for patients who do not develop them (Thomas, 2001). This evidence alone shows how significant this problem is to the overall health status of patients. In my personal nursing experience, I have heard many complaints voiced from patients and their family members concerning the development of new pressure ulcers. Patients and family members have expressed dissatisfaction because of the increased stress and prolonged hospital stay often associated with the treatment of pressure ulcers.

Although the situation was quite challenging, it provided me with some useful experiences for the future practice. I understand that all institutions should have a policy for documenting the assessment of patients, including pressure ulcers (Morison 2001). I have come to be familiar with the homes assessment policy using the Sterling Pressure Sore Severity Scale and most importantly I have learned that by using a universal assessment tool it supports a systemic and consistent approach to pressure ulcer evaluation. This therefore supporting continuity of care.

Braden scale is a tool used to predict patient’s risk for pressure ulcer. However, when this tool is not used to its fullest potential, it does not help to decrease the patient’s risk of developing pressure ulcers. Many over look a Braden score of sixteen is being high and not at risk but, scores under eighteen are considered to at risk for pressure ulcer development. Nursing interventions need to be in place before a new development of pressure ulcers. Nurses need to use these provided tools and carry out appropriate nursing interventions according to the results. When a nursing care is not a written requirement, many nurses overlook the benefits of the tool and neglect to provide the best nursing care.

Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et

Pressure ulcers are a problem and can lead to poor patient outcomes as well as hospital fines. Evidence based studies have shown that “the average cost of care in an acute care hospital for a patient with a stage III or stage IV pressure ulcer reported by the Centers for Medicare & Medicaid Services (CMS) is $43,180” (Jackson, 2008). Pressure ulcers and other skin breakdowns are among the most significant adverse events causing distress for patients and their care givers and compromising patients’ recovery from illness or injury (Gardiner, 2008). It is the tasks of nurses to ensure prevention of these complications is part of the daily care regimen.

• Nutrition- Mani (2003) claims that nutrition is a fundamental role that must be adopted in the treatment and healing process of pressure ulcers. A balanced diet with adequate nutrients should be key for all patients deemed to be at risk of pressure ulcers. Both nutrition and hydration are the basic components in promoting wound healing and maintaining normal tissue integrity. Patients at risk of pressure ulcers should be nutritionally assessed at regular intervals (Shepard. 2003). This could have been adopted by the use of assessment tools such as, The Nutritional Screening initiative. This tool includes nutritional screening at regular intervals and a comprehensive assessment that includes nutritional assessment, functional assessment and evaluation for depression. This comprehensive approach allows the nurse to quantify the nutritional problems and initiate the appropriate resources that will meet with the individual needs (Bryant, 2000). Another optional tool is the Malnutrition Universal Screening Tool or MUST. This has been designed by the Malnutrition Advisory Group (MAG) of the British

Pressure ulcers during a hospital admission are preventable. Assessment and early intervention can stop skin breakdown before it begins. Many factors regarding Mr. J’s condition placed him at a high risk regarding nursing indicators. Mild dementia, recent fall and a fractured hip all require a high level of nursing care and indicates preventative practice. Upon assessment, precautions should be in place to deter further complications. The elderly are more

To start the search for evidence within University Hospital, questions were asked in regards to pressure ulcers. Monthly updates are often sent out via email from the wound care team to keep everyone up to date on knowledge. While there was informative numbers within those updates, this information falls short according to Moore, Webster, & Samuriwo (2015). The main limitation of the study is the lack of a control group in pressure ulcer prevention and treatment. There is no clarity in the specific criterion that contributed to improved clinical outcomes. Teams used more than one method in the research project. Also, there is no study that meant the inclusion criteria in the random clinical trials. The lack of standardized

The primary goals for conducting nursing research are to generate new knowledge to promote positive outcomes for patients, enhance quality and cost-effectiveness of care, improve the healthcare delivery system, and validate the credibility of the nursing profession through evidence-based practice (Schmidt & Brown, 2012). The purpose of this paper is to explore the practice-related problem of pressure ulcers and the importance of the problem in the nursing profession.

Despite advancement of technology, pressure ulcer continues to be a primordial in the health care system. Prevention of pressure ulcer remains an important issue in the health care facility. The critically ill ICU patient is the main target of this disease. Prevention remains the key for this problem. Some facility have standard policy for the eradication of pressure ulcer However the question is will the sacrum pressure ulcer formation be reduced in adult critically ill clients

In the article “The Pain Scale”, Biss is giving a proposal to definition of the pain scale. The author scaled the pain in a numeric values represented by a scale from zero to ten. First, is the zero scale. As Biss described herself as some one who generate question instead of answering them, she thinks that pain cannot be eliminated. Meaning, zero cannot explain a situation, just like its numerical value, we cannot apply some computational operations to it. Then, the author goes to explain how zero is interpreted in Celsius and Kelvin. To illustrate her point, she used the chicken as an example. The concept of the chicken example is that when we grab the chicken by its feet and the chicken is not complaining, that does not mean that the chicken is in no pain. The moral of zero pain is that either the pain cannot be expressed or it can not be felt. Second, the author started with the stories of how she was taught what is pain and who invented the scale of zero to ten pain scale. For example, Biss’s father told her that an itch is just a damaged tissue. Biss then asks a very complex question, she said “When does pain worth measuring? With poison ivy? With a hang nail?… A razor cut?” This shows how complex it is to judge where the pain begins. Even with a trained hospice nurses, not every pain can be identified. Biss conclude the scale one by assuming that zero and one are close to each other to the point where they might equal each other. Third, the scale number two starts

According to the Agency for Healthcare Research and Quality (AHRQ), 2.5 million patients are affected by pressure ulcers and incur costs anywhere from $9.1 billion to $11.6 billion per year in the United States (AHRQ, 2014). As of October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) will not reimburse hospitals for cases in which the pressure ulcer was acquired after admission (CMS, 2008). Because of this high cost, the number of patients affected each year, and insurances no longer reimbursing hospital acquired pressure ulcers (HAPU), an accurate skin assessment upon admission is critical to reduce costs, ease pain in patients, and lower incidences of pressure ulcers. This paper will address what leadership and management skills and functions are required of a wound care nurse who identifies a problem with the accuracy of skin assessments on newly admitted patients.

The INTACT trial showed a significant reduction in pressure ulcers (PU) incidence in the intervention group at the hospital (cluster) level, but this difference was not significant at the

In fact, according to Oliveira de Carvalho, Gomes, Tavares Gomes, Perrelli Valença, & de Almeida Cavalcanti (2015), the Braden Scales daily use is essential for the nurse to utilize while assess other risk factors that can also lead to pressure injuries. Several methods were used in the collection of data, including surveys, randomized trials, questionnaires and interviews were conducted with both the patients as well as the members of the health care team. All of the studies focused on patients receiving inpatient care in the acute care setting. Every article identified HAPUs as a significant issue that deserved priority consideration, and acknowledged the benefit of the Braden Scale as a significant tool to aid in their prevention .

No decision was reached in Butterworth on whether such a ‘feeding’ of the buyers title could operate to prevent an action for total failure of consideration. Pearson J however, considered that it would be an extraordinary position if the claimant, should, where good title has already passed, seek to say that ‘there has been a total failure of consideration by the purchaser of this car, although here is the car in my possession and I am entitled to retain it against the world’.