The Interrater Agreement for the Assessment of Pressure Ulcer Risk Using the Braden Scale and the Classification of Pressure Ulcers by Nurses in A Medium-Sized Hospital

Hyung-Ju Na; Sung-Hee Yoo; Young-Ran Kwon; Min-Jeng Ahn

doi:10.7475/kjan.2020.32.1.35

Journal List > Korean J Adult Nurs > v.32(1) > 1142896

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Na, Yoo, Kwon, and Ahn: The Interrater Agreement for the Assessment of Pressure Ulcer Risk Using the Braden Scale and the Classification of Pressure Ulcers by Nurses in A Medium-Sized Hospital

Original Article

Korean Journal of Adult Nursing 2020; 32(1): 35-45.

Published online: 20 February 2020

DOI: https://doi.org/10.7475/kjan.2020.32.1.35

The Interrater Agreement for the Assessment of Pressure Ulcer Risk Using the Braden Scale and the Classification of Pressure Ulcers by Nurses in A Medium-Sized Hospital

Hyung-Ju Na¹

, Sung-Hee Yoo²

, Young-Ran Kwon²

, Min-Jeng Ahn²

¹Wound, Ostomy, Continence-Nursing Specialist, Metropolitan Dongbu Hospital, Seoul, Korea.

²Associate Professor, College of Nursing, Chonnam National University, Gwangju, Korea.

Corresponding author: Yoo, Sung-Hee. College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea. Tel: +82-62-530-4941, Fax: +82-62-62-227-4009, shyoo@jnu.ac.kr

Received 10 September 2019 Revised 5 December 2019 Accepted 1 January 2020

Korean Society of Adult Nursing

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This methodological study was conducted to evaluate the interrater agreement in pressure ulcer risk assessment using the Braden scale, and in pressure ulcer classification, by nurses in a medium-sized hospital.

Methods

Data were collected from a medium-sized hospital, located in Seoul, from December 18, 2017 to February 28, 2018. The author (Rater 1) and 20 randomly sampled nurses (Rater 2) independently assessed 100 patients. The Braden scale for risk assessment and the six-stage pressure ulcer classification system were used. The interrater agreement was evaluated using the Intraclass Correlation Coefficient (ICC), the proportion of agreement (Po), and the Bland-Altman plots.

Results

For the total score on the Braden scale, the ICC was .85 and the Po was .29. Among the scale items, ‘moisture’ had the lowest agreement (ICC=.55, Po=.46). The interrater agreement had Po values of .84 and .69 for the presence and the classification of pressure ulcers, respectively.

Conclusion

For nurses in medium-sized hospitals, interrater agreement for the Braden scale and for the classification of pressure ulcers should be enhanced. In order to do this, overall institutional support is needed, including training in the accurate use of tools for pressure ulcer care.

Keywords: Pressure ulcer, Braden scale, Observer variation, Risk assessment

Figures and Tables

Figure 1

Bland-Altman plots for braden scale score between raters.

Table 1

Interrater Agreement for the Braden Scale Score and Classification of Pressure Ulcers according to Departments

CI=confidence interval; ICC=intraclass correlation coefficients; ICU=intensive care unit; PU=pressure ulcers; SD=standard deviation.

p value were calculated by Fishers exact test for categorical variables, and Kruskal wallis test for continuous variables. This p value (^†) was calculated by ANCOVA, after adjusting for patients' gender as a covariate (F=0.65, p=.423).

Table 2

Interrater Agreement for the Braden Scale Score and the Presence of High Risk Group for Pressure Ulcer (N=100)

CI=confidence interval; ICC=intraclass correlation coefficient; Po=proportion of agreement.

Table 3

Proportion of Agreement about the Presence of High Risk Group for Pressure Ulcer (N=100)

The proportion of agreement about the presence of high risk group for pressure ulcer (≤12 or>12 score of Braden scale) was .77.

Table 4

Interrater Agreement for the Classification of Pressure Ulcers (N=100)

CI=confidence interval; ICC=intraclass correlation coefficient; Po=proportion of agreement; S-DTI=suspected deep tissue injury stage.

ACKNOWLEDGEMENT

This article is a revision of the first author's master's thesis from Chonnam National University.

Notes

^{CONFLICTS OF INTEREST} The authors declared no conflict of interest.

^AUTHORSHIP

Study conception and design acquisition: NH-J, YS-H, KY-R and AM-J.
Data collection: NH-J.
Analysis and interpretation of the data: NH-J and YS-H.
Drafting and critical revision of the manuscript: NH-J, YS-H, KY-R and AM-J.

References

1. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Haesler Emily, editor. Prevention and treatment of pressure ulcers: clinical practice guideline. 2nd ed. Osborne Park, Western Australia: Cambridge Media;2014. p. 44–45.

2. Jun SS, Kim HJ, Jang YJ. Pressure ulcers caused by equipment and supplies in intensive care unit. Journal of Korean Academic Society of Home Care Nursing. 2017; 24(3):255–263. DOI: 10.22705/jkashcn.2017.24.3.255.

3. Lee SJ, Jeong JS, Lim KC, Park EY, Kim HY. Factors influencing on pressure ulcer incidence among older patients with hip fracture in a hospital. Journal of Korean Biological Nursing Science. 2019; 21(1):54–61. DOI: 10.7586/jkbns.2019.21.1.54.

4. Moore Z, Avsar P, Conaty L, Moore DH, Patton D, O'Connor T. The prevalence of pressure ulcers in Europe, what does the European data tell us: a systematic review. Journal of Wound Care. 2019; 28(11):710–719. DOI: 10.12968/jowc.2019.28.11.710.

5. Mizokami F, Furuta K, Isogai Z. Necrotizing soft tissue infections developing from pressure ulcers. Journal of Tissue Viability. 2014; 23(1):1–6. DOI: 10.1016/j.jtv.2013.11.001.

6. Lim ML, Ang SY. Impact of hospital-acquired pressure injuries on hospital costs - experience of a tertiary hospital in Singapore. Infection Control and Hospital Epidemiology. 2017; 25(1):42–47.

7. Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for predicting pressure sore risk. Nursing Research. 1987; 36(4):205–210.

8. Park SH, Park YS. Predictive validity of the Braden scale for pressure ulcer risk: a meta-analysis. Journal of Korean Academy of Nursing. 2014; 44(6):595–607. DOI: 10.4040/jkan.2014.44.6.595.

9. Kottner J, Dassen T. Interpreting interrater reliability coefficients of the Braden scale: a discussion paper. International Journal of Nursing Studies. 2008; 45(8):1238–1246. DOI: 10.1016/j.ijnurstu.2007.08.001.

10. Han IK, Jeong IS. Interrater reliability of the braden scale. Journal of the Korean Data Analysis Society. 2012; 14(2):867–879.

11. Kwon EO, Eom IH, Chang SJ, Shim MY, Lee SH. Accuracy of nurses' assessment of pressure ulcers in hospitalized patients. Journal of Korean Clinical Nursing Research. 2012; 18(1):29–38. DOI: 10.22650/JKCNR.2012.18.1.29.

12. Kottner J, Dassen T. Pressure ulcer risk assessment in critical care: interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units. International Journal of Nursing Studies. 2010; 47(6):671–677. DOI: 10.1016/j.ijnurstu.2009.11.005.

13. Kottner J, Halfens R, Dassen T. An interrater reliability study of the assessment of pressure ulcer risk using the Braden scale and the classification of pressure ulcers in a home care setting. International Journal of Nursing Studies. 2009; 46(10):1307–1312. DOI: 10.1016/j.ijnurstu.2009.03.014.

14. Black J, Baharestani M, Cuddigan J, Dorner B, Edsberg L, Langemo D, et al. National pressure ulcer advisory panel's updated pressure ulcer staging system. Advances in Skin & Wound Care. 2007; 20(5):269–274. DOI: 10.1097/01.ASW.0000269314.23015.e9.

15. Nixon J, Tohorpe H, Barrow H, Phillips A, Nelson EA, Mason SA, et al. Reliability of pressure ulcer classification and diagnosis. Journal of Advanced Nursing. 2005; 50(6):613–623. DOI: 10.1111/j.1365-2648.2005.03439.x.

16. Defloor T, Schoonhoven L, Katrien V, Weststrate J, Myny D. Reliability of the European Pressure Ulcer Advisory Panel classification system. Journal of Advanced Nursing. 2006; 54(2):189–198. DOI: 10.1111/j.1365-2648.2006.03801.x.

17. Lee YJ, Park SM, Kim JY, Kim CG, Cha SK. Clinical nurses' knowledge and visual differentiation ability in pressure ulcer classification system and incontinence-associated dermatitis. Journal of Korean Academy of Nursing. 2013; 43(4):526–535. DOI: 10.4040/jkan.2013.43.4.526.

18. Lee EJ, Yang SO. Clinical knowledge and actual performance of pressure ulcer care by hospital nurses. Journal of Korean Clinical Nursing Research. 2011; 17(2):251–261.

19. Nam MJ. Nurse's nursing knowledge and nursing performance of pressure sores; focused on medium hospital and long term care hospital for old people [master's thesis]. Naju: Dongshin University;2015.

20. Giraudeau B, Mary JY. Planning a reproducibility study: how many subjects and how many replicates per subject for an expected width of the 95 percent Confidence interval of the intraclass correlation coefficient. Statistics in Medicine. 2001; 20(21):3205–3214. DOI: 10.1002/sim.935.

21. Han SY, Nam JM, Myung SM, Song KJ. A comparison of sample size requirements for Intraclass Correlation Coefficient (ICC). The Korean Journal of Applied Statistics. 2010; 23(3):497–510. DOI: 10.5351/KJAS.2010.23.3.497.

22. Braden BJ, Maklebust J. Preventing pressure ulcers with the Braden scale: an update on this easy to use tool that assesses a patient's risk. American Journal of Nursing. 2005; 105(6):70–72.

23. Korean Hospital Nurses Association. Prevention and management of pressure ulcer [Internet]. Evidence-Based Clinical Nursing Practice Guideline: Korean Hospital Nurses Association;2013. cited 2018 March 3. Available from: https://khna.or.kr/home/data/khna_guide_ebp02.pdf.

24. Kottner J, Dassen T. An interrater reliability study of the braden scale in two nursing homes. International Journal of Nursing Studies. 2008; 45(10):1501–1511. DOI: 10.1016/j.ijnurstu.2008.02.007.

25. Cha JS, Kim YB. An analytical of interrater reliability & agreement. Korea Business Review. 1994; 23(special):75–102.

26. Kim DH, Jeong HS, Lee DW. Evaluation of risk for pressure ulcers using braden scale in elderly patients receiving long-term care. Journal of the Korean Geriatrics Society. 2011; 15(4):191–199. DOI: 10.4235/jkgs.2011.15.4.191.

TOOLS

ORCID iDs

Hyung-Ju Na
https://orcid.org/0000-0003-2303-1304

Sung-Hee Yoo
https://orcid.org/0000-0002-0951-1670

Young-Ran Kwon
https://orcid.org/0000-0002-4885-4238

Min-Jeng Ahn
https://orcid.org/0000-0003-4318-8755

Similar articles