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Multisite Web-Based Training in Using the Braden Scale to Predict Pressure Sore Risk

Magnan, Morris A. PhD, RN; Maklebust, JoAnn MSN, APRN,BC, AOCN, FAAN

Advances in Skin & Wound Care: March 2008 - Volume 21 - Issue 3 - pp 124-133
doi: 10.1097/01.ASW.0000305420.73597.d2
Features: Original Investigation

OBJECTIVE: To evaluate the effect of a Web-based Braden Scale training module on nurses' knowledge of pressure-ulcer risk assessment and prevention.

DESIGN: Pre-experimental, posttest-only design.

SETTING: Web-based learning environment.

PARTICIPANTS: Registered nurses (N = 1391) working at 3 medical centers in the Midwest.

MAIN OUTCOME MEASURES: Primary outcomes of interest were reliability and competence associated with using the Braden Scale for pressure-ulcer risk assessment. Secondary outcomes of interest focused on program evaluation, specifically nurses' perceptions of program adequacy and ease of use.

MAIN RESULTS: After training, nurses correctly rated Braden Scale level of risk 82.6% of the time. Numeric ratings for Braden subscales were generally more reliable when case-study data indicated extreme risk levels (generally not at-risk level, high-risk level, and very high level) than when data indicated midlevels of risk (mild-risk level and moderate-risk level). Nurses' knowledge of appropriate risk-based preventive interventions was high, but correlated poorly with the ability to correctly assign numeric ratings to Braden subscales.

CONCLUSION: Web-based training alone may not ensure reliable, competent estimates of pressure-ulcer risk for patients at all risk levels. Other strategies, such as clinical practice with expert supervision, should be considered. Further research is needed to clarify the links between scoring Braden subscales correctly and selecting appropriate risk-based preventive interventions.

Morris A. Magnan, PhD, RN, and JoAnn Maklebust, MSN, APRN,BC, AOCN, FAAN This study evaluated the effect of a Web-based Braden Scale training module on nurses' knowledge of pressure-ulcer risk assessment and prevention. Nearly 1400 nurses participated in the Web-based training and testing program.

At the time of this study, Morris A. Magnan, PhD, RN, was an Assistant Professor of Nursing, School of Nursing, Oakland University, Rochester, MI, and an Associate Research Professor, College of Nursing, Wayne State University, Detroit, MI. JoAnn Maklebust, MSN, APRN,BC, AOCN, FAAN, is a Clinical Nurse Specialist and Wound Care Nurse Practitioner, Oncologic Surgery Karmanos Cancer Center, Detroit Medical Center, and an Adjunct Associate Clinical Professor, College of Nursing, Wayne State University, Detroit, MI.

This study was supported in part by a grant from the Blue Cross Blue Shield of Michigan Foundation. Additional support was provided by an Intramural Research Support grant from Oakland University. Correspondence may be addressed to Dr Magnan at morrismagnan@yahoo.com.

Submitted July 31, 2007 accepted in revised form October 18, 2007.

© 2008 Lippincott Williams & Wilkins, Inc.