Pressure ulcer risk screening in hospitals and nursing homes with a general nursing assessment tool: evaluation of the care dependency scale.

RATIONALE: In view of an increasing necessity for systematic assessments, nursing practice would benefit from a simplification of assessment procedures. These assessments should be scientifically based. AIMS: To evaluate the possibility of assessing pressure ulcer risk as well as care dependency simultaneously with a standardized instrument for nursing homes and hospitals. METHODS: Care dependency was measured with the Care Dependency Scale (CDS). The quantitative analyses were accomplished with data from a cross-sectional study that was performed in 2005 in 39 German nursing homes and 37 hospitals with a total of more than 10,000 participants. The scale's construct validity was calculated with Pearson's r, and predictive validity was evaluated by computing sensitivity and specificity values and the area under the curve (AUC). Item-level analyses included calculations of odds ratios, relative risks and logistic regression analyses. RESULTS: Construct validity of the CDS was r = 0.79 (P < 0.01) in nursing homes and r = 0.89 (P < 0.01) in hospitals. AUC was 0.80 in hospitals and 0.65 in nursing homes. Analyses on item level identified 'mobility' as a key item in both settings and additional differing key items for nursing homes and hospitals. CONCLUSIONS: The CDS is a well-functioning tool for pressure ulcer risk detection in hospitals. For this purpose, the most appropriate cut-off point is 69 while special regard is given to the items 'continence', 'mobility' and 'hygiene'. In nursing homes the usefulness of the CDS for pressure ulcer risk detection is limited. Here, the most appropriate cut-off point is 41 and attention is given to the items 'mobility', 'getting (un)dressed', 'hygiene' and 'avoidance of danger'.

Using the Care Dependency Scale for fall risk screening.

AIM: This paper is a report of a study conducted to estimate the sensitivity and specificity of the Care Dependency Scale as a measure of risk of falling for individuals in hospital and nursing home settings. BACKGROUND: Falls and their consequences are common problems in hospitals and nursing homes and nurses should assess the potential risks of their patients. Items in fall risk scales resemble a general nursing assessment, which leads to redundant assessment procedures. It would be beneficial to have a single generic instrument for general assessment and fall risk screening. METHODS: Standardized questionnaires were used in a cross-sectional study in 2004 and data were gathered from 9943 German nursing home residents and hospital patients (response rate 77.1%). Sensitivity and specificity of all Care Dependency Scale scores were calculated for fall risk. Relationships between the 15 scale items and falls were described using odds ratios and logistic regression analysis. FINDINGS: Patients with falls in hospitals were more care dependent than those without falls. Sensitivity and specificity values showed that with the Care Dependency Scale a differentiation is possible between the falls group and the no-falls group. High odds ratios and logistic regression analysis suggest that the Care Dependency Scale item 'Avoidance of danger' indicated fall risk. Nursing home residents with and without falls had similar care dependency scores. CONCLUSION: Nursing assessment in hospitals could be simplified by using the Care Dependency Scale for fall risk screening. Its value in fall risk screening in nursing homes requires further testing.