Exploring the Barden Scale as a Vital Risk

Introduction

In nursing, risk assessment is the evaluation process of identifying hazards and risks in the care environment or workplace which may cause potential harm to the patients, staffs, visitors and others along with the way the risks are to be resolved (Maguire et al. 2018). Thus, risk assessment is essential to develop measures to ensure the safety and protection of individuals. In this essay, the overview and importance regarding Barden Scale as risk assessment tool is to be discussed. The risk factors involved in Barden Scale and actions to be implemented to resolve the risks are to be discussed.

Overview of Barden Scale

Barden Scale is referred to the risk assessment tool developed in 1987 for the purpose of assisting health professionals, mainly nurses, to assess risk of development of a pressure ulcer on a patient (oxfordhealth.nhs.uk, 2014). In the scale, six categories are examined (sensory perception, activity, moisture, mobility, nutrition, friction and shear) and to rate each of them from a score of 1-4 points is used expect friction and shear which is rated from 1-3 points in the scale. A score of 23 points on the scale on addition of all points from the six categories indicates that a person has no risk of experiencing development of pressure ulcer but the lower the score the riskier it is for the person to develop pressure ulcer. The score of 9 or less is regarded as too much risk for the person to develop pressure ulcer (NICE, 2015).

Importance of Barden Scale in risk assessment

The pressure ulcers are the localised damage to the tissues on the skin as well as underlying tissues resulting from long-term pressure on the skin combined with shear stress. It is likely to occur over bony prominences and among people who are terminally-ill with mainly compromised or restricted mobility (Boyko et al. 2018). In the respect, Barden Scale as risk assessment tool is important because identification of risk of development of pressure ulcer in terminally-ill people with hindered mobility would make nurses aware and take prior action to lower the risks. This is, in turn, is going to enhance the health and well-being of the individuals by lowering some of their suffering from the additional pain to be caused by pressure ulcer apart from their hindered long-term health condition (Watkins et al. 2019). The NHS reports that increasing incidence of pressure ulcer is going to cost them £1.74 billion within 1 year from its onset in 2018 in case its annual prevalence increase remains the same (Mccoulough, 2019). Thus, Barden Scale is important as risk assessment through it may act to lower the annual incidence of the disease by making nurses aware of risk of the disease in the care settings to take effective actions in managing and preventing it. This, in turn, would act to lower financial burden to be held by NHS for pressure ulcer management among individuals.

In the UK, it is mentioned that 4-10% of the patients who are admitted for care to the hospital develop pressure ulcers (NHS England, 2014). In England and Wales, nearly 700,000 people each year are found to develop pressure ulcer while availing care in different settings like home, hospitals and others with the most vulnerable individuals found to be aged 75 years and over. It is found that nearly 186,617 of these incidences of reported pressure ulcer occurs at hospital which leads more than £4,000 additional finances to be spent for care in the hospitals (NHS England, 2014; gov.wales, 2018). In Scotland, it is reported that nearly 1 in 150 people in the population and 1 in 23 people in the population who are above 65 years develops pressure ulcer (pressureulcer.scot, 2018). Thus, it indicates that there is high prevalence of pressure ulcer among the elderly in the UK. In this case, the use of Barden Scale is important as it is going to aware nurses of the risk factors to be assessed that are raising the incidence of the disease, in turn, making them aware of effective preventive measures to be taken to successfully lower its prevalence.

Identifying risk factors involved in Barden Scale

The risk factors included in the risk assessment of Barden Scale includes sensory perception as the initial factor. The sensory perception is the ability of a patient to detect and provide response towards the pain or discomfort developed out of pressure in the body. The lack of consciousness of pain or senses in the body makes patients at risk of developing pressure ulcer as they are unable to cognitively react to the discomfort executed by the pressure. This, in turn, leads to support continuous damage to the tissues in the body that later takes the form of ulcer (Chen et al. 2017). For example, people living with paralysis have high risk of pressure ulcer as their limited mobility along with lack of sensation creates devastating complication to develop pressure ulcer (Cowan et al. 2019). The mobility factor is also highlighted as risk factor in the Barden Scale. For example, in case of terminally-ill people of older age, it is seen that they are unable to move and remains confined at single place in a similar position due to disease burden raising chances of pressure ulcer in them. This is because prolonged pressure on the single muscles leads towards their damage and deformity that later promotes development of pressure ulcer (Flett et al. 2019).

In Barden Scale, moisture is referred as one of the key risk factors for pressure ulcer. This is because excessive presence of moisture with continuity on the skin posses risk for the skin integrity to be compromised. It causes the tissues on the skin to be macerated which creates risk to develop epidermal erosion that exposes the inner surface of the skin to be inflamed and infection resulting to form ulceration (Alderden et al. 2017; Bates‐Jensen et al. 2017). The Barden Scale mentions that physical activity is another vital factor to act as risk for pressure ulcer. This is because lower physical activity by the patients leads them to develop muscles atrophy and breakdown of the tissues that contribute to ulcer formation (Skogestad et al. 2017). As argued by Chen et al. (2017), in Barden Scale, lack of nutrition and lower hydration are referred to risk factors for pressure ulcer. This is because hindered nutrition contributes to inefficient functioning of the immune system along with tensile strength and collagen synthesis in the muscles. It contributes to ulcer formation as they lead the body to show inefficiency to heal wounds or fight against infections to allow healing of ulcers (Cowan et al. 2016).

The friction and shear in the Barden Scale are reported to be risk factor for pressure ulcer. The friction and shear refer to understanding of the amount of assistance needed for moving and degree of sliding faced by patients on chairs and bed. This acts as risk factor for pressure ulcer as sliding is able to cause shear meaning the bone and skin to be moved in opposite direction that leads to breakdown of capillaries and cell membrane. The presence of moisture acts as additional factor for susceptibility of friction among individuals while lying or sitting (Cabrejo et al. 2018).

Discussion of actions to be implemented for addressing risk factors identified involving the multi-agency practice

The nurses to control the risk identified through Braden Scale on the basis of the score for each category are to take active steps to resolve them to prevent patient from experiencing pressure ulcer. In order to manage shear and friction, the nurses are to use pad and protectors (foam dressing, silicon pad, others) for the vulnerable areas in the patients that are at risk of developing pressure ulcer. This is because the pad and protectors act as barriers for the skin and muscles to experience friction and shear by redistributing the pressure (Boyko et al. 2018). For example, foam mattress, air-control mattress, effective positioning on wheelchairs is to be used as protectors from friction and shear risk that leads to pressure ulcer (Beeckman et al. 2019). As argued by Armour et al. (2019), mobility and activity risk of pressure ulcer is to be resolved by the nurses by continuously assisting to change the position of lying and sitting of the individuals who are unable to move. This is because it would avoid build up of pressure at single point in the body that in turn would keep away deformity of the muscle integrity which results in ulcerations. The nurses while caring for the pressure ulcer patients is to ensure they are not positioned with ulceration on the pressure sides as it would lead to deteriorated impact on the individual (Mervis and Phillips, 2019).

The nutrition and hydration efficiency of the individuals at risk of pressure ulcer is to be checked and the nurses are to maintain a well-planned diet for the individuals so that enough nutrient and water required by the body for its proper functioning is present (Taylor, 2017). In this purpose, the multi-agency team is required to include nutritionist for the patients with risk of pressure ulcer. This is because nutritionist has effective ability to determine the supplements and balanced diet to be suggested to the patients and way hydration is to be managed for them to ensure they avoid pressure ulcer development (Fleurke et al. 2020). The multi-agency team involves various nature of healthcare professionals with diverse expertise from different organisation who work collaboratively in treatment of patients regarding any health issue (Ng et al. 2020). In order to manage risk of moisture, the nurses are to ensure the skin remains dry so that epidermal erosion or maceration does not occur on the skin. They are to ensure it by cleaning the skin after any incidence of incontinence, dry skin moistening on daily basis, assessment of key pressure points and others (Mervis and Phillips, 2019). In this purpose, a dermatologist in the multi-agency team is to be included as they have effective ability to assess the skin condition and inform medications to be used for faster wound healing and management of skin in patients with risk of pressure ulcer (Fujimoto et al. 2020).

Conclusion

The above discussion mentions that Barden Scale is prominent risk management tool used to determine risk of pressure ulcer. It is important to be used as it ensures well-being of individuals, lower financial for pressure ulcer management on healthcare bodies and raises awareness of the risk to be managed to control its prevalence. The risk factors to be controlled are moisture, sensory impairment, mobility, activity, shear and friction and nutrition. The multi-agency team for pressure ulcer management is required to have dermatologist, nutritionist and nurses along with health professionals for ensuring health and well-being regarding the disease.

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References

• Alderden, J., Cummins, M., Pepper, G., Whitney, J., Wilson, A., Butcher, R., Zhang, Y. and Thomas, D., 2017. Mid-range Braden subscale scores are associated with increased risk for pressure injury development among critical care patients. Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society, 44(5), p.420.
• Armour, D.J., Preston-Hsu, E. and Tailor, Y., 2019. Management of Pressure Ulcers and Pressure-Related Injury. Current Physical Medicine and Rehabilitation Reports, 7(2), pp.170-177.
• Bates‐Jensen, B.M., McCreath, H.E. and Patlan, A., 2017. Subepidermal moisture detection of pressure induced tissue damage on the trunk: The pressure ulcer detection study outcomes. Wound Repair and Regeneration, 25(3), pp.502-511.
• Beeckman, D., Serraes, B., Anrys, C., Van Tiggelen, H., Van Hecke, A. and Verhaeghe, S., 2019. A multicentre prospective randomised controlled clinical trial comparing the effectiveness and cost of a static air mattress and alternating air pressure mattress to prevent pressure ulcers in nursing home residents. International journal of nursing studies, 97, pp.105-113.
• Boyko, T.V., Longaker, M.T. and Yang, G.P., 2018. Review of the current management of pressure ulcers. Advances in wound care, 7(2), pp.57-67. Boyko, T.V., Longaker, M.T. and Yang, G.P., 2018. Review of the current management of pressure ulcers. Advances in wound care, 7(2), pp.57-67.
• Cabrejo, R., Ndon, S., Saberski, E., Chuang, C. and Hsia, H.C., 2018. Deterioration of sensory perception or friction & shear in low risk braden scores is associated with accelerated development of hospital acquired pressure ulcers. Plastic and Reconstructive Surgery–Global Open, 6(4S), p.52. Chen, H.L., Cao, Y.J., Shen, W.Q. and Zhu, B., 2017. Construct Validity of the Braden Scale for Pressure Ulcer Assessment in Acute Care: A Structural Equation Modeling Approach. Ostomy/wound management, 63(2), pp.38-41.
• Chen, H.L., Cao, Y.J., Zhang, W., Wang, J. and Huai, B.S., 2017. Braden scale (ALB) for assessing pressure ulcer risk in hospital patients: A validity and reliability study. Applied Nursing Research, 33, pp.169-174. Cowan, L., Garvan, C., Kent, C. and Stechmiller, J., 2016. How Well Does the Braden Nutrition Subscale Agree With the VA Nutrition Classification Scheme Related to Pressure Ulcer Risk?. Federal Practitioner, 33(12), p.12.
• Cowan, L.J., Ahn, H., Flores, M., Yarrow, J., Barks, L.S., Garvan, C., Weaver, M.T. and Stechmiller, J., 2019. Pressure ulcer prevalence by level of paralysis in patients with spinal cord injury in long-term care. Advances in skin & wound care, 32(3), pp.122-130. england.nhs.uk 2014, Help nurses care – A view from the front line on the ‘Stop the Pressure’ campaign, Available at: https://www.england.nhs.uk/blog/stop-the-pressure/ [Accessed on: 9th May 2020]
• Flett, H.M., Delparte, J.J., Scovil, C.Y., Higgins, J., Laramée, M.T. and Burns, A.S., 2019. Determining Pressure Injury Risk on Admission to Inpatient Spinal Cord Injury Rehabilitation: A Comparison of the FIM, Spinal Cord Injury Pressure Ulcer Scale, and Braden Scale. Archives of physical medicine and rehabilitation, 100(10), pp.1881-1887.
• Fleurke, M., Voskuil, D.W. and Beneken genaamd Kolmer, D.M., 2020. The role of the dietitian in the management of malnutrition in the elderly: A systematic review of current practices. Nutrition & Dietetics, 77(1), pp.60-75. Fujimoto, M., Asai, J., Asano, Y., Ishii, T., Iwata, Y., Kawakami, T., Kodera, M., Abe, M., Amano, M., Ikegami, R. and Isei, T., 2020. Wound, pressure ulcer and burn guidelines–4: Guidelines for the management of connective tissue disease/vasculitis‐associated skin ulcers. The Journal of Dermatology. pp.21-29.
• gov.wales 2018, Welsh Health Circular, Available at: https://gov.wales/sites/default/files/publications/2019-07/welsh-health-circular-on-revised-pressure-ulcer-reporting-including-the-reporting-of-serious-incidents.pdf [Accessed on: 9th May 2020]
• Maguire, T., Daffern, M., Bowe, S.J. and McKenna, B., 2018. Risk assessment and subsequent nursing interventions in a forensic mental health inpatient setting: Associations and impact on aggressive behaviour. Journal of clinical nursing, 27(5-6), pp.e971-e983. Mccoulough, S., 2019. What's the cost of pressure ulcers in your organisation?, Available at: https://oska.uk.com/journal/feeding-the-skin-ywxrl [Accessed on: 9th May 2020]
• Mervis, J.S. and Phillips, T.J., 2019. Pressure ulcers: prevention and management. Journal of the American Academy of Dermatology, 81(4), pp.893-902.
• Ng, W.C., Lim, Z.Z. and Kadir, M.M., 2020. A Multidisciplinary Care Management Approach to Preventing and Managing Elder Abuse: The Singapore Experience. In International Handbook of Elder Abuse and Mistreatment (pp. 485-510). Springer, Singapore.
• NICE 2015, Pressure ulcers, Available at: https://www.nice.org.uk/guidance/qs89/chapter/Quality-statement-3-Pressure-ulcer-risk-reassessment [Accessed on: 9th May 2020]
• oxfordhealth.nhs.uk 2014, Pressure Ulcer Risk Assessment: The Braden Scale, Available at: https://www.oxfordhealth.nhs.uk/wp-content/uploads/2015/08/Braden-teaching.pdf [Accessed on: 9th May 2020]
• pressureulcer.scot 2018, Reducing Pressure Ulcers in Care Homes, Available at: http://www.pressureulcer.scot/ [Accessed on: 9th May 2020]
• Skogestad, I.J., Martinsen, L., Børsting, T.E., Granheim, T.I., Ludvigsen, E.S., Gay, C.L. and Lerdal, A., 2017. Supplementing the Braden scale for pressure ulcer risk among medical inpatients: The contribution of self‐reported symptoms and standard laboratory tests. Journal of clinical nursing, 26(1-2), pp.202-214.
• Taylor, C., 2017. Importance of nutrition in preventing and treating pressure ulcers. Nursing older people, 29(6). Watkins, A.A., Castillo-Angeles, M., Calvillo-Ortiz, R., Guetter, C.R., Eskander, M.F., Ghaffarpasand, E., Anguiano-Landa, L., Tseng, J.F., Moser, A.J., Callery, M.P. and Kent, T.S.,
• 2019. Braden scale for pressure ulcer risk predicts rehabilitation placement after pancreatic resection. HPB, 21(7), pp.923-927.