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The risk of pressure ulcers is widely assessed using the Braden Scale for Predicting Pressure Ulcer Risk, which describes patient characteristics for various severity levels. However, many of these characteristics are described in vague terms that nurses may interpret inconsistently, potentially threatening scale reliability. To examine the consistency of nurses' interpretations of five vaguely described patient characteristics on the Braden Scale we surveyed a convenience sample of 102 nurses and compared their interpretations with those of two nurse experts. The results show large variations in nurses' interpretations. Although the highest frequency of nurses' responses to the majority of descriptions was consistent with the experts' interpretation, the large variation in responses may seriously threaten consistent and accurate assessment of pressure-ulcer risk with the Braden Scale. Our findings suggest that training programs provide operational definitions of these vague patient descriptions, so the Braden Scale can be used consistently in patient care.

The article presents a study describing nursing workload, patient acuity, and length of stay (LOS) and their relationship through a case study of Spaulding Rehabilitation Hospital (SRH) in Boston, Massachusetts. Changes in patient profile were investigated during two periods, between July 2002 and September 2006, and between October 2006 and September 2008. During the study, a 10% or more increase was observed in the categories of close observation, cardiovascular/neurologic management, information/instructional needs, educational needs/lifestyle change, and coping support. It also shows that patients admitted to SRH need intense nursing care.