Braden Subscale Explained: Caregiver’s Guide! MUST Read

Understanding pressure ulcer risk is crucial for effective patient care, and the Braden Scale is a cornerstone assessment tool in that process. Hospitals and long-term care facilities rely on the Braden Scale, and especially the braden subscale components, to evaluate patient vulnerability. Norton Scale is another risk assessment model, the Braden Scale offers a more granular look at specific risk factors, empowering caregivers to create targeted prevention strategies. By understanding each element within the braden subscale, and how it contributes to the overall score, caregivers can significantly improve patient outcomes and reduce the incidence of pressure injuries.

Understanding the Braden Subscale: A Comprehensive Guide for Caregivers

The Braden Scale is a widely used tool for assessing a patient’s risk of developing pressure ulcers (bedsores). It doesn’t just give an overall score; it breaks down the assessment into six key "subscales," each examining a different factor that contributes to pressure ulcer development. As a caregiver, understanding these subscales is crucial for providing effective preventative care. Let’s explore each subscale and what it means for your loved one.

Sensory Perception Subscale

This subscale evaluates the patient’s ability to feel and respond to discomfort or pain. It’s not just about whether they can feel, but also whether they respond appropriately to that feeling by shifting position or asking for help.

Levels of Sensory Perception

• Completely Limited: The patient is unresponsive to painful stimuli or has altered sensorium that limits the ability to feel pain over most of their body surface. This indicates a very high risk.
• Very Limited: The patient responds only to painful stimuli and cannot communicate discomfort or requires restraints that limit ability to feel pressure over most of the body. This also represents a high risk.
• Slightly Limited: The patient responds to verbal commands but cannot always communicate discomfort or need to be turned.
• No Impairment: The patient responds to verbal commands, has no sensory deficit that would limit ability to feel or voice pain or discomfort.

Caregiver Considerations for Sensory Perception

• Regular Skin Checks: If sensory perception is limited, carefully and regularly inspect the skin for any signs of redness or breakdown, especially over bony prominences (hips, heels, tailbone).
• Repositioning: Implement a regular repositioning schedule (e.g., every two hours, or more frequently if needed).
• Communication: Encourage the patient to communicate any discomfort, even if it seems minor. If they can’t communicate verbally, look for non-verbal cues of pain or distress (facial expressions, restlessness).
• Assistive Devices: Utilize pressure-redistributing surfaces (mattresses, cushions) and protective barriers (e.g., heel protectors).

Moisture Subscale

This subscale assesses the degree to which the skin is exposed to moisture. Excessive moisture weakens the skin and makes it more vulnerable to breakdown.

Levels of Moisture

• Constantly Moist: Skin is kept moist almost constantly by perspiration, urine, or fecal incontinence. This represents a significant risk.
• Very Moist: Skin is often, but not always, moist. Linen must be changed at least once per shift.
• Occasionally Moist: Skin is occasionally moist, requiring an occasional linen change.
• Rarely Moist: Skin is usually dry; linen requires changing only at routine intervals.

Caregiver Considerations for Moisture

• Prompt Cleaning: Immediately clean and dry the skin after episodes of incontinence or excessive sweating.
• Protective Barriers: Apply a moisture barrier cream or ointment to protect the skin from prolonged exposure to moisture.
• Manage Incontinence: Work with healthcare professionals to manage incontinence issues (e.g., bladder training, appropriate absorbent products).
• Ventilation: Ensure adequate ventilation to reduce sweating. Loose-fitting clothing can also help.

Activity Subscale

This subscale assesses the patient’s level of physical activity. Limited activity increases the risk of pressure ulcers because it reduces blood flow to the skin.

Levels of Activity

• Bedfast: Confined to bed.
• Chairfast: Ability to sit in a chair is limited.
• Walks Occasionally: Walks occasionally during day, but very short distances, with or without assistance. Spends majority of each shift in bed or chair.
• Walks Frequently: Walks outside the room at least twice a day and inside the room at least every 2 hours during waking hours.

Caregiver Considerations for Activity

• Encourage Movement: Encourage even limited movement, such as repositioning in bed or performing range-of-motion exercises.
• Assist with Ambulation: Provide assistance with ambulation to promote circulation and reduce pressure on vulnerable areas.
• Chair Selection: Ensure that chairs are appropriately padded and provide adequate support. Limit the time spent sitting in one position.
• Regular Repositioning: Even for bedfast or chairfast patients, regular repositioning is crucial to redistribute pressure.

Mobility Subscale

This subscale assesses the patient’s ability to change and control body position. Someone who can’t easily adjust themselves is at higher risk of developing pressure ulcers.

Levels of Mobility

• Completely Immobile: Does not make even slight changes in body or extremity position without assistance.
• Very Limited: Makes occasional slight changes in body or extremity position but unable to make frequent or significant shifts independently.
• Slightly Limited: Makes frequent though slight changes in body or extremity position independently.
• No Limitations: Makes major and frequent changes in position without assistance.

Caregiver Considerations for Mobility

• Assist with Repositioning: Provide assistance with repositioning to relieve pressure on vulnerable areas.
• Specialized Equipment: Utilize specialized equipment, such as trapeze bars or turning devices, to facilitate repositioning.
• Support Surfaces: Employ pressure-redistributing mattresses, cushions, and other support surfaces.
• Education: Educate the patient and other caregivers about the importance of regular repositioning.

Nutrition Subscale

This subscale assesses the patient’s usual food intake pattern. Adequate nutrition is essential for maintaining healthy skin and promoting healing.

Levels of Nutrition

• Very Poor: Never eats a complete meal. Rarely eats more than 1/3 of any food offered. Eats 2 servings or less of protein (meat or dairy products) per day. Takes fluids poorly. Not taking a dietary supplement, OR is NPO (nothing by mouth) and/or maintained on clear liquids or IV for more than 5 days.
• Probably Inadequate: Rarely eats a complete meal and generally eats only about 1/2 of any food offered. Protein intake includes only 3 servings of meat or dairy products per day. Occasionally will take a dietary supplement OR receives less than optimum amount of liquid diet or tube feeding.
• Adequate: Eats over half of most meals. Eats a total of 4 servings of protein (meat, dairy products) each day. Occasionally refuses a meal, but will usually take a supplement if offered OR is on a tube feeding or TPN regimen which presumably meets most nutritional needs.
• Excellent: Eats most of every meal. Never refuses a meal. Usually eats a total of 4 or more servings of protein. Occasionally eats between meals. Does not require supplementation.

Caregiver Considerations for Nutrition

• Monitor Intake: Carefully monitor the patient’s food and fluid intake.
• Provide Nutritious Meals: Offer nutritious, well-balanced meals and snacks that are rich in protein, vitamins, and minerals.
• Supplementation: Consult with a healthcare professional about the need for dietary supplements.
• Address Barriers: Identify and address any barriers to adequate nutrition, such as difficulty chewing or swallowing, loss of appetite, or medication side effects.

Friction and Shear Subscale

This subscale assesses the amount of friction and shear force to which the patient’s skin is exposed. Friction occurs when skin rubs against a surface, while shear occurs when layers of skin slide against each other. Both can damage the skin and increase the risk of pressure ulcers.

Levels of Friction and Shear

• Problem: Requires moderate to maximum assistance in moving. Complete lifting without sliding against sheets is impossible. Frequently slides down in bed or chair, requiring frequent repositioning with maximum assistance. Spasticity, contractures, or agitation lead to almost constant friction.
• Potential Problem: Moves feebly or requires minimum assistance. During a move skin probably slides to some extent against sheets, chair, restraints, or other devices. Maintains relatively good position in chair or bed most of the time but occasionally slides down.
• No Apparent Problem: Moves in bed and in chair independently and has sufficient muscle strength to lift up completely during move. Maintains good position in bed or chair.

Caregiver Considerations for Friction and Shear

• Proper Lifting Techniques: Use proper lifting techniques to minimize friction and shear during transfers and repositioning.
• Assistive Devices: Utilize assistive devices, such as slide sheets or trapeze bars, to reduce friction and shear.
• Smooth Surfaces: Ensure that bed linens and clothing are smooth and wrinkle-free.
• Positioning: Position the patient in a way that minimizes friction and shear forces, such as using pillows to support body parts and prevent sliding.

By understanding these Braden subscales, you can better assess your loved one’s risk for pressure ulcers and implement effective preventative measures. Remember to consult with healthcare professionals for personalized guidance and treatment.

Alright, now you’ve got a solid grasp on the braden subscale! Go out there and use this knowledge to provide the best possible care. Remember, every little bit helps!