Date of Award


Document Type

Doctor of Nursing Practice (DNP)

Degree Name

Doctor of Nursing Practice (DNP)



Committee Chair

Elizabeth Barnby

Committee Member

Shannon Graham


Bedsores--Risk assessment, Intensive care nursing


Pressure injuries are "reasonably preventable" with evidence-based care. Risk assessment is the cornerstone of evidence-based pressure injury prevention. In the United States, the Braden Scale for Predicting Pressure Ulcer Risk (Braden Scale) is the most common pressure injury risk assessment tool. Conversely, the Braden Scale lacks adequate validation in the critical care setting, omits important predictors of pressure injury risk for critically ill patients, and may be too cumbersome for timely and effective employment in this high acuity unit. The project addresses this gap through optimization of the Norton Pressure Sore Risk Assessment Scale (Norton Scale) for use in the critical care setting. A video simulated patient scenario was used by critical care nurses (CCN) and certified wound care nurses (CWCN) at the project site to evaluate the optimized Norton Scale (oNS) for usability, interrater reliability, and its ability to predict pressure injury risk among patients with critical illness. The oNS proved to be an easy to use, critical-care specific risk assessment tool that demonstrated optimal reliability, predictive validity, and interrater reliability among CCNs at the project site.



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