The Braden Scale: A Foundational Tool in Patient Care
The Braden Scale for Predicting Pressure Sore Risk is a clinically validated tool used by healthcare professionals, particularly nurses, to assess a patient's risk of developing a pressure injury (also known as a pressure ulcer or bedsore) [1.7.1]. Developed in 1987 by Barbara Braden and Nancy Bergstrom, the scale helps caregivers implement preventative measures tailored to an individual's specific needs [1.7.5]. A low score indicates a high risk, while a high score suggests a low risk. The total score ranges from 6 to 23 [1.4.2]. A score of 17 falls into the 'mild risk' category, signaling that while the risk isn't severe, preventative actions are necessary [1.2.4].
Deconstructing the Score: The Six Subscales
The total Braden score is calculated from six individual subscales. Each is rated on a point scale, typically from 1 to 4, except for Friction & Shear [1.7.3]. Understanding each component is crucial to interpreting a score of 17.
- Sensory Perception: This assesses the patient's ability to feel and respond to pain or pressure-related discomfort [1.4.2]. A lower score means the patient may not recognize the need to shift their weight.
- Moisture: This evaluates the degree to which the skin is exposed to moisture from sources like sweat, urine, or stool, which can compromise skin integrity [1.7.1].
- Activity: This measures the patient's degree of physical activity. It considers how much they move around, from being bedfast to walking frequently [1.7.2].
- Mobility: This is different from activity; it assesses the patient's ability to change and control their own body position while in bed or a chair [1.4.2].
- Nutrition: This evaluates the patient's usual food intake pattern. Poor nutrition can impede the body's ability to maintain healthy skin and heal wounds [1.7.1].
- Friction and Shear: This subscale (scored 1–3) looks at the mechanical forces that can damage skin, such as a patient sliding down in bed [1.7.3].
Interpreting the Scores: What a 17 Signifies
A score of 17 places a patient in the 'mild risk' category, which typically spans from 15 to 18 [1.3.2, 1.7.4]. While not as critical as the 'moderate' (13-14) or 'high risk' (10-12) categories, a mild risk score is not a signal for inaction. It indicates that one or more risk factors are present and require attention. For example, a patient might be fully mobile and active but have inadequate nutrition, or they may be well-nourished but have slightly limited mobility. The total score prompts clinicians to look closer at the subscale scores to pinpoint the exact areas of concern.
Braden Scale Risk Level Comparison
| Score Range | Risk Level |
|---|---|
| 19–23 | No Risk |
| 15–18 | Mild Risk |
| 13–14 | Moderate Risk |
| 10–12 | High Risk |
| ≤ 9 | Very High Risk |
(Source: Based on data from multiple sources [1.2.1, 1.2.4, 1.3.3])
Clinical Interventions for a Mild Risk (Score 17)
For a patient with a Braden score of 17, the goal is to implement a proactive, preventative care plan. Interventions are based on which subscale scores are low and may include [1.5.2, 1.5.3]:
- Establish a Turning Schedule: If mobility or activity is a contributing factor, ensure the patient is repositioned frequently to relieve pressure on bony prominences [1.5.3]. For patients who can move independently, encourage small shifts in weight.
- Protect Heels and Pressure Points: Heels are particularly vulnerable. Use pillows to elevate the heels completely off the bed surface or use heel protector boots [1.5.1].
- Manage Skin Moisture: Conduct regular skin assessments, at least once per shift. Use moisture barrier creams to protect skin from incontinence. Ensure linens are kept clean, dry, and wrinkle-free [1.5.4]. Avoid hot water and use mild cleansers [1.5.1].
- Optimize Nutrition and Hydration: If the nutrition score is low, consult with a dietitian. Encourage adequate intake of protein and calories, which are vital for skin health [1.5.3]. Offer fluids regularly to maintain hydration.
- Minimize Friction and Shear: When repositioning the patient, use a lift sheet to avoid dragging them across the bed linens. Keep the head of thebed elevated no more than 30 degrees unless medically necessary to reduce sliding [1.5.3].
- Patient and Family Education: Educate the patient and their family on the importance of these preventative measures, such as repositioning techniques and signs of early skin damage to report [1.5.2].
Conclusion: From Assessment to Action
A Braden Scale score of 17 is a crucial indicator that a patient is at mild risk for developing a painful and potentially dangerous pressure injury. It is not just a number to be charted; it is a clinical directive for a targeted, preventative care plan. By analyzing the subscale scores and implementing specific interventions, healthcare providers can protect skin integrity, improve patient comfort, and prevent the complications associated with pressure ulcers. Proactive care is always more effective than reactive treatment. For more in-depth guidelines on pressure injury prevention, the National Pressure Injury Advisory Panel (NPIAP) provides authoritative resources.
