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


Elke Mertens
Department of Nursing Science
Centre for the Humanities and Health Sciences
Charité– Universitätsmedizin Berlin
Charitéplatz 1, 10117 Berlin


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’.