Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2023


Doctor of Nursing Practice (DNP)

Primary Advisor

Dr. Qiuping Zhou


Braden Scale, Jackson/Cubbin Scale, Hospital Acquired Pressure Injury, Intensive Care Unit, Adult Inpatient


Background: Pressure injuries in acute care patients cause thousands of deaths and billions of losses annually. The Braden Scale has been an American standard of pressure injury risk assessment yet demonstrates poor predictability in the Intensive Care Unit (ICU) population. Recent evidence indicates that the Jackson/Cubbin Scale performs similarly or superiorly to the standard.

Purpose: To compare the Jackson/Cubbin Scale to the Braden Scale in assessing ICU patients’ risk for pressure injuries and resulting nursing interventions. Methods: Using a pretest-posttest and comparative design, trained nurses in two ICUs applied both Jackson/Cubbin Scale and Braden Scale to assess patients’ risks twice daily. The identification ability, resulting nursing interventions, and incidence/prevalence of skin injuries were compared.

Results: 128 patients were assessed over two months. There was a significant correlation between the tools’ performance. Jackson/Cubbin Scale classified 33.6% of patients being at “high risk” and 33.9% at “very high risk”, whereas Braden Scale classified 26.3% at “high risk” and 3.6% at “very high risk”. All patients received pressure injury prevention interventions. Concurrently, there was a 21.6% increase in pressure injury prevention interventions applied to any patient scoring “at risk” or higher. Hospital Acquired Pressure Injury prevalence/incidence declined during study period.

Conclusions/implications: Most objectives were met and sustained beyond the project. Nurse surveys demonstrate that most believe that the Jackson/Cubbin Scale is valuable to their practice, more sensitive to the needs of critical care patients, and easier to apply than the Braden Scale. Further evaluation will be performed including all ICUs in the organization.

Open Access


Available for download on Friday, September 20, 2024

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Nursing Commons