Frank Watkins

The association of BMI and Braden total score on the occurrence of pressure ulcers.

PURPOSE: We compared pressure ulcer (PU) prevalence patients with a body mass index (BMI) of 40 or more, and Braden Scale scores of 16 or more to patients with lower BMI. METHODS A cross-sectional study by using existing data was conducted combining patient skin status with BMI. Subjects underwent skin assessment for evidence of skin breakdown by nurses trained in PU assessment. Data from this assessment were combined with historic data gathered from review of medical records and BMI. SUBJECTS AND SETTING: The study was carried out in a tertiary medical center in Eastern North Carolina. Three hundred sixty-two patients were included in the prevalence study. RESULTS: Fourteen percent of all patients had at least 1 PU. The prevalence among patients with a BMI of less than 40 was 12.5% as compared to 26% in patients with a BMI of more than 40 (P 5 .01). When controlling for the effects of BMI, patients with a Braden Scale score of 16 or less were almost 6 times more likely to have a PU as compared to those with Braden Scale scores of more than 16 (P, .001). Body mass index had an independent association with the probability of PU occurrence. Patients with BMIs of more than 40 were almost 3 times more likely to have a PU compared to those with BMIs of 40 or less, after controlling for Braden risk (P 5 .01). CONCLUSION: A BMI of more than 40 and Braden Scale score of 16 or less were found to have an independent and statistically significant association with PU occurrence. Future studies should investigate the predictive validity of BMI along with individual Braden subscales.

Caring for morbidly obese patients: safety considerations for nurse administrators.

The publication of the Institute of Medicines To Err Is Human: Building a Safer Health System in 1999 and Patient Safety: Achieving a New Standard of Care in 2003 sparked the development of patient safety indicators, the establishment of safety goals as part of the accreditation process, and improvement in reporting systems.1-3 While these efforts have been directed at safety in general, little attention has been paid to safety considerations in the care of hospitalized patients who are morbidly obese. Yet these patients are seen with increasing frequency in hospitals. They may be under care for bariatric surgery, treatment of comorbidities, or other unrelated conditions such as childbirth or trauma. Whatever their reason for entering the healthcare system, these patients may be at increased risk for falls and other adverse reactions or near misses due to their large body mass. In addition, some evidence suggests that nurses themselves are at heightened risk for injury when caring for morbidly obese patients.

The relationship between pressure ulcer prevalence, body mass index, and Braden scales and subscales: a further analysis.

ABSTRACTThe purpose of this study was to evaluate whether any of the Braden subscales were more strongly related to pressure ulcer occurrence than the Braden total score in obese and nonobese hospitalized patients. The authors investigated whether defining high risk for the total Braden score of 16 or less was associated with pressure ulcer occurrence.

Challenges in caring for morbidly obese patients.

This study aimed to determine how morbidly obese patients and their families manage activities of daily living (ADLs) at home. A survey design was used for this descriptive study. Home healthcare professionals identified both challenges and innovations in managing the ADLs of the morbidly obese in the home.

Research in the Rehabilitation Unit Presents Challenges to Nurse Researchers

Purpose: Gathering data from patients on a rehabilitation unit poses challenges for nurse researchers. Design: A case study is presented that describes ways the researchers attempted to meet these challenges while conducting their study. Methods: The case study presents the approaches that the investigators took to undertake the study and then described the ways in which these approaches could have been improved. Findings: Their successes and failures are described. Conclusions: Suggestions are made for future investigators. Clinical Relevance: Clinical nursing research is required to develop an evidence base for practice in the rehabilitation unit. An analysis of the challenges and possible methods of overcoming these challenges is useful to both future investigators and nurses in practice to insure that studies can be carried out effectively.