Origins and Purpose of the Braden Scale
Developed in 1987 by nurses Barbara Braden and Nancy Bergstrom, the Braden Scale provides a systematic and reliable way to predict pressure injury risk. It standardized an assessment process that was previously inconsistent, allowing for early identification of at-risk individuals and the implementation of tailored interventions. Preventing pressure injuries is vital due to the pain, infection risk, longer hospital stays, and increased costs they can cause. The Braden Scale is now a core part of skin and wound care across various healthcare settings.
The Six Subscales: What Do They Measure?
The Braden Scale uses six subscales to evaluate different factors contributing to pressure injury risk. Each, except for Friction and Shear, is scored 1 to 4, with lower scores indicating higher risk. Understanding these components is key to interpreting the total score and creating effective care plans.
Sensory Perception
This subscale assesses a patient's ability to sense and respond to discomfort related to pressure. Impaired perception can prevent a patient from feeling or communicating the need to reposition.
Moisture
This measures the skin's exposure to moisture from sources like sweat, urine, or wound drainage. Excessive moisture can soften the skin, making it vulnerable to breakdown.
Activity
The Activity subscale evaluates a patient's physical activity level, such as how often they walk or get out of bed. Limited activity increases the risk of tissue breakdown.
Mobility
This assesses a patient's ability to change and control their body position independently. Those unable to reposition easily or without help are at higher risk.
Nutrition
Poor nutrition compromises tissue health and healing ability. This subscale assesses the patient's typical food intake in terms of quantity and quality.
Friction and Shear
Scored from 1 to 3, this subscale measures the forces that damage tissue when skin slides against a surface. Friction is rubbing, while shear is when skin and bone move in opposite directions.
Scoring and Interpretation
Summing the scores from the six subscales gives a total Braden score between 6 and 23, indicating the overall risk level. A lower score means a higher risk.
Braden Score Risk Levels:
- 19-23: No risk
- 15-18: Mild risk
- 13-14: Moderate risk
- 10-12: High risk
- ≤ 9: Severe risk
Assessment should occur upon admission and regularly thereafter, or when a patient's condition changes.
Braden Scale vs. Norton Scale
While Braden is prevalent, the Norton Scale is another validated tool. The table below highlights key differences.
| Feature | Braden Scale | Norton Scale |
|---|---|---|
| Year Developed | 1987 | 1962 |
| Subscales | 6 | 5 |
| Scoring Range | 6-23 | 5-20 |
| Risk Interpretation | Lower score = higher risk | Lower score = higher risk |
| Friction/Shear | Dedicated subscale | Combined with mobility |
The Braden Scale is widely used partly due to its specific inclusion of moisture and sensory perception.
Implementing Braden Scale-Based Interventions
Braden Scale scores guide targeted interventions. For example, a low nutrition score may require dietary support, while low mobility may require frequent repositioning and pressure-relieving surfaces. Key prevention strategies include:
- Frequent repositioning
- Moisture management
- Nutritional support
- Specialty surfaces
- Skin protection
These strategies help caregivers provide proactive, individualized care and reduce pressure injury risk. For more details on prevention, consult resources like the Agency for Healthcare Research and Quality.
The Role of the Braden Scale in Senior Care
The Braden Scale is crucial in senior care, as many older adults have risk factors like limited mobility, decreased sensation, and malnutrition. Regular Braden assessments in long-term care and home settings ensure care teams are aligned on risk status and prevention. While effective, the scale should be used with clinical judgment, considering other factors like medical devices that may increase risk.
Conclusion
The Braden Scale is a foundational, evidence-based tool for assessing pressure ulcer risk. By evaluating six key factors, it allows healthcare professionals to shift from reactive treatment to proactive prevention. This is especially important for seniors and other vulnerable populations. Its consistent use, combined with clinical expertise, is essential for high-quality patient care and wound prevention.
