Complications of adapting pressure ulcer risk assessment scales.
This article challenges recommendations to adapt a pressure ulcer risk assessment scale (RAS) according to the clinical context. The transformation of the Cubbin and Jackson (1991) RAS is used to illustrate problems in scale development. When new factors are added to an existing scale, this can lead to unnecessary complexity. When words are changed by a person developing a scale this illustrates their differing beliefs and value judgements. Arbitrary scores for factors are misleading and in some cases mystifying, yet appear to be objective. This article suggests that the relationship between sub-scales and the whole scale have not been adequately accounted for -- they can't simply be added up arithmetically. The paradox of risk is debated, namely, that the more something is thought to be a risk, the less risky it becomes. RASs should be replaced by risk reduction scales linking a risk factor with its outcome following intervention.
Maylor
Miles E
ME
Tissue Viability, Oxford Radcliffe NHS Trust, John Radcliffe Hospital, UK.
D000203:Activities of Daily Living; D001291:Attitude of Health Personnel; D015986:Confounding Factors, Epidemiologic; D003625:Data Collection / Q000379:methods / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006439:Hemodynamics; D006801:Humans; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D015403:Nursing Evaluation Research; D009740:Nursing Staff / Q000193:education / Q000523:psychology; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000145:classification / Q000175:diagnosis* / Q000451:nursing; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index