title: A Mixed-methods Study to Assess Interrater Reliability and Nurse Perception of the Braden Scale in a Tertiary Acute Care Setting.
abstract: Research regarding the reliability of the Braden Scale and nurses' perspectives on the instrument for predicting pressure ulcer (PU) risk in acute care settings is limited. A mixed-methods study was conducted in a tertiary acute care facility to examine interrater reliability (IRR) of the Braden Scale and its subscales, and a qualitative survey using semi-structured interviews was conducted among nurses caring for patients in acute care units to gain nurse perspective regarding scale usability. Data were extracted from a previous retrospective, randomized, controlled trial involving adult patients with compromised mobility receiving care in a tertiary acute care hospital in Canada. One-way, intraclass correlation coefficients (ICCs) were calculated on item and total scores, and kappa statistics were used to determine reliability of categorizing patients on their risk. Interview results were categorized by common themes. Reliability was assessed on 64 patients, where nurses and research staff independently assessed enrolled participants at baseline and after 72 hours using the Braden Scale as it appeared on an electronic medical record. IRR for the total score was high (ICC = 0.807). The friction and shear item had the lowest reliability (ICC = 0.266). Reliability of categorizing patients' level of risk had moderate agreement (κ = 0.408). Three (3) major and 12 subthemes emerged from the 14 nurse interviews; nurses were aware of the scale's purpose but were uncertain of its effectiveness, some items were difficult to rate, and questions were raised as to whether using the scale enhanced patient care. Aspects identified by nurses to enhance usability included: 1) changes to the electronic version (incorporating the scale into daily assessment documents with readily available item descriptions), 2) additional training, and 3) easily available resource material to improve reliability and usability of scale. These findings need to be considered when using the Braden Scale in clinical practice. Further study of the value of the total Braden Scale and its subscales is warranted.
authors.affiliation: Cumming School of Medicine, University of Calgary; and Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, University of Calgary and Alberta Health Services at the Foothills Medical Centre, Calgary, AB, Canada.
authors.forename: Chester H
authors.initials: CH
authors.lastname: Ho
authors.affiliation: W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary.
authors.forename: Amanda
authors.initials: A
authors.lastname: Cheung
authors.affiliation: O'Brien Institute of Public Health; and W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary.
authors.forename: Danielle
authors.initials: D
authors.lastname: Southern
authors.affiliation: W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary.
authors.forename: Wrechelle
authors.initials: W
authors.lastname: Ocampo
authors.affiliation: W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary.
authors.forename: Jaime
authors.initials: J
authors.lastname: Kaufman
authors.affiliation: the Brenda Strafford Foundation in Geriatric Medicine, University of Calgary.
authors.forename: David B
authors.initials: DB
authors.lastname: Hogan
authors.affiliation: W21C Research and Innovation Centre; and Department of Medicine, Division of General Internal Medicine, Cumming School of Medicine, University of Calgary.
authors.forename: Barry
authors.initials: B
authors.lastname: Baylis
authors.affiliation: W21C Research and Innovation Centre, Cumming School of Medicine; Departments of Medicine and Infection Prevention and Control, Alberta Health Services; and O'Brien Institute for Public Health, University of Calgary.
authors.forename: John M
authors.initials: JM
authors.lastname: Conly
authors.affiliation: Alberta Health Services' Critical Care Strategic Clinical Network; the Departments of Critical Care Medicine, Medicine and Community Health Sciences, University of Calgary; and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.affiliation: O'Brien Institute for Public Health, Foothills Medical Centre, University of Calgary; W21C Research and Innovation Centre; and Departments of Community Health Sciences and General Internal Medicine, Cumming School of Medicine.
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000592:standards; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards*; D010465:Perception; D003668:Pressure Ulcer / Q000145:classification*; D036301:Qualitative Research; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D011795:Surveys and Questionnaires; D000078329:Workforce