| Background:Pressure injury,or PI,which was called pressure ulcer in the past,is a circumscribed injury that occurres on the skin and(or)under the potential of subcutaneous soft tissue.It usually occurs in the bone promontory,and mostly caused by pressure or joint shear force.The high risk group of pressure injury are people who loss mobility,such as the elderly patients in bed.Moreover,the elderly patients are facing with more complex pressure injury problems due to the decline of physiological organ function and digestive system function.With the ever-deepening understanding of the relationship between stress-assessed scale(RAS)and stress-induced injury,stress screening and assessment of accurate and effective stress-induced injury have been conducted.Based on this,The implementation of targeted nursing intervention gradually attracted attention.Structured risk-assessment tools of pressure injury,which has been widely used in clinical nursing work,can assess the risk of patients’ pressure injury quickly and scientifically with the advantages of convenience,economy and noninvasiveness.There has been more than ten kinds of pressure injury risk-assessment scales(RAS)which successively developed in clinical use since 1860s.But only three of them are used commonly in the research and clinical practice at home and abroad--there are Braden scale,Waterlow scale and Norton scale-and they also has its advantages and disadvantages because of two reasons:on one hand,the major difference of the choice of research methods and study populationl,on the other,the lack of prediction and assessment on the elderly.As the deepened understanding of the relationship between RAS and pressure injury,it is brought to the forefront to implementing targeted nursing intervention on the basis of the accurate and effective screening and evaluation of pressure injury risk.The lack of specific quantification of each of its assessment items,and in particular the fact that the nutrition items therein were considered by many studies to be a cause of low Cronbach’s alpha.Thus,the clinical appearance of some modified Braden score scale,such as the Braden Q score scale used in children with stress injury risk assessment.OH scale is modified from the Braden scale,which is now widely used by the Japanese health ministry.It has simplified as four evaluation contents:the capacity of changing positions,pathological bone atrophy,edema,and joints,which has been widely used in nursing homes in Japan and also be proved to have good validity among patients with malignant tumor in China.But its application of the elderly patients in China has rarely been reported.This research aims at comparing and discussing the results of OH scale and Braden scale in predicting the risk of pressure injury of elderly patients and providing the basis for clinical nursing staff to effectively select RAS when receiving patients.Objectives:To compare the reliability and validity of two stress injury RAS(OH score scale and Braden’s score scale),so as to predict the risk of stress injury in elderly patients and to select the appropriate RAS for clinical nurses to quickly and intuitively identify the elderly patients correctly.The degree of stress injury risk and quickly takes the appropriate and effective preventive measures to provide a theoretical basis.Materials and Methods:In this study,a cross-sectional survey was conducted and the sample was sampled by hand.The elderly hospitalized patients whose overall Barthel self-care ability index was less than 60 were selected as study subjects.The scores of OH score 124 cases of elderly patients were scored on-site pressure injury risk scale and Braden score scale to evaluate the effect of two kinds of RAS on the prediction of stress injury in elderly hospitalized patients.Pearson correlation coefficient,Cronbach’s alpha coefficient,sensitivity,specificity,predictive value and receiver operator characteristic curve(ROC)and area under under the ROC curve,AUC),evaluation of time-consuming and other indicators to evaluate the predictive ability of two kinds of RAS.(Using Cronbach’s alpha to evaluate the internal consistency reliability of the scale;analyzing the impact of each item within the two RASs on the entire scale through item sensitivity;using the Pearson correlation to calculate the same scale for different nurses The correlation coefficients of the scores of the two RAS were evaluated.The internal consistency reliability of the RAS was evaluated by the Cronbach’s a coefficient.The structural validity of the two RASs was evaluated by the maximum variance rotation method.The predictive validity of the two risk assessment scales was analyzed by ROC curve.The AUC,sensitivity and specificity of the two RAS were compared.The differences between the two risk assessment scales and the actual incidence were compared by chi-square test.P<0.05,the difference was statistically significant;P<0.05,the difference was highly statistically significant.Outcomes:1.On the day of investigation,11 of 124 elderly hospitalized patients developed pressure injury,with a rate of 8.9%.One of the patients suffered from two stages of stress injury(9.0%),and the rest were stage 1 stress injury.Nurses took 100%of patients to keep the bed clean and dry,99.2%of patients scheduled to help Q1-2h stand up measures,the use of decompression mattress in 107 patients.2.The reliability of the two stress injury risk assessors was high,the correlation coefficient of Braden score was 0.967,the correlation coefficient of OH score was 0.995,the calculated Steigers Z statistic was Z = 14.896,and the difference was statistically significant(P<0.05).3.The Cronbach’s alpha coefficient of the Braden scale was 0.598-0.601,and the Cronbach’s alpha coefficients after removing one item were 0.586-0.598,of which the Cronbach alpha coefficient was the highest(0.654)after removing the"nutrition" item;The Cronbach alpha coefficient of the scale was the lowest at 0.578 after removing the "move" item.While the Cronbach’s alpha coefficients after removing one item from the four items of OH scale were 0.649-0.687,of which the Cronbach alpha coefficient was the highest(0.687);The Cronbach alpha coefficient of the scale was the lowest at 0.649 after removing the "joint contracture" item.4.The KMO value of Braden’s scale was 0.654,Bartlett’s test was 56.78,P<0.05,while KMO value of OH was 0.785,Bartlett’s test was 87.62,P<0.05.After the factor analysis,there are two factors each with the Braden and OH scales greater than 1,while the cumulative variance of the Braden and OH scales is respectively 50.688%and 66.626%(eigenvalues 1).5.OH twice the risk of stress damage rating scale assessment scores were 0.722 AUC,risk of injury stress twice Braden Scale score evaluation score of AUC were 0.483 and 0.531,OH scale twice the AUC P<0.05;Braden sensitive tangent point rating scale was 14 points,and OH sensitive tangential point rating scale was 5 points,the sensitivity and specificity were relatively balance.6.The assessment of the risk of stress injury in nurses using the OH scale was(1.57 ± 0.74)min,significantly lower than that using the Braden scale(3.63 ± 2.21)min,and the difference between the two scores was(-2.26 ± 2.13)min and(-2.16 ±2.22)min,and the difference was statistically significant(P<0.001)Conclusions:The Braden score internal consistency reliability is lower than the OH score scale,and the Cronbach alpha coefficient of the Braden score scale is the highest after removing nutrition items.At each recommended diagnostic cutoff,the Braden score was less than optimally sensitive and specific,and its AUC was low.The predictive validity of Braden’s scale in elderly inpatient reliability and validity is not ideal.The OH rating scale is superior to the Braden rating scale in assessing the risk of stress injury in elderly patients and is more suitable for predicting the risk of stress injury in elderly patients with disability.Preventive measures may be over-pressured by clinical nurses on stress injury in elderly patients with disability. |
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