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The Effect of Web-Based Braden Scale Training on the Reliability of Braden Subscale Ratings

Magnan, Morris A.; Maklebust, JoAnn

Journal of Wound, Ostomy and Continence Nursing: January-February 2009 - Volume 36 - Issue 1 - p 51–59
doi: 10.1097/WON.0b013e3181919b8d

PURPOSE The primary purpose of this study was to evaluate the effect of Web-based Braden Scale training on the reliability of Braden Scale subscale ratings made by nurses working in acute care hospitals. A secondary purpose was to describe the distribution of reliable Braden subscale ratings before and after Web-based Braden Scale training.

DESIGN Secondary analysis of data from a recently completed quasi-experimental, pretest-posttest, interrater reliability study.

SUBJECTS AND SETTING A convenience sample of RNs working at 3 Michigan medical centers voluntarily participated in the study. RN participants included nurses who used the Braden Scale regularly at their place of employment (“regular users”) as well as nurses who did not use the Braden Scale at their place of employment (“new users”).

METHODS Using a pretest-posttest, quasi-experimental design, pretest interrater reliability data were collected to identify the percentage of nurses making reliable Braden subscale assessments. Nurses then completed a Web-based Braden Scale training module after which posttest interrater reliability data were collected. The reliability of nurses' Braden subscale ratings was determined by examining the level of agreement/disagreement between ratings made by an RN and an “expert” rating the same patient. In total, 381 RN-to-expert dyads were available for analysis.

RESULTS During both the pretest and posttest periods, the percentage of reliable subscale ratings was highest for the activity subscale, lowest for the moisture subscale, and second lowest for the nutrition subscale. With Web-based Braden Scale training, the percentage of reliable Braden subscale ratings made by new users increased for all 6 subscales with statistically significant improvements in the percentage of reliable assessments made on 3 subscales: sensory-perception, moisture, and mobility. Training had virtually no effect on the percentage of reliable subscale ratings made by regular users of the Braden Scale.

CONCLUSION With Web-based Braden Scale training the percentage of nurses making reliable ratings increased for all 6 subscales, but this was true for new users only. Additional research is needed to identify educational approaches that effectively improve and sustain the reliability of subscale ratings among regular users of the Braden Scale. Moreover, special attention needs to be given to ensuring that all nurses working with the Braden Scale have a clear understanding of the intended meanings and correct approaches to rating moisture and nutrition subscales.

Morris A. Magnan, PhD, RN, RN Care Manager, Emergency Department, St Joseph Mercy Oakland, Pontiac, Michigan.

JoAnn Maklebust, MSN, APRN-BC, AOCN, FAAN, Clinical Nurse Specialist/Wound Care and Nurse Practitioner, Oncologic Surgery, Karmanos Cancer Center, Detroit, Michigan, and Adjunct Associate Clinical Professor, College of Nursing, Wayne State University, Detroit, Michigan.

Corresponding author: JoAnn Maklebust, MSN, APRN-BC, AOCN, FAAN (

Copyright © 2009 by the Wound, Ostomy and Continence Nurses Society