These Nursing Students Could Change the Future of Pressure-Wound Monitoring

• Three Western Michigan University nursing students worked with Ascension Borgess to conduct a study that would determine if a new risk-assessment scale could be beneficial in pressure-wound monitoring.
• The students used the Shieh Score, which was created in 2019.
• Since the late 1980s, the Braden Scale has been the industry standard for pressure-wound monitoring.

Three Western Michigan University nursing students could usher in change related to pressure-wound monitoring. 

Maddie Bies, David Le, and Jordyn Swenson are working with Ascension Borgess to determine if a “new pressure ulcer risk assessment scale” would improve patient care.

Dave Neuman, wound ostomy coordinator at Ascension Borgess, said the WMU students are analyzing internal data using the Shieh Score to determine if the hospital could have “capture[d] more patients who would have been pressure-injury risks who were not labeled as risks.”

The students, who are in their final semester, are participating in the research as part of their nursing leadership and management course in the Bronson School of Nursing.

“The fact that we’re last-year nursing students on the forefront of this effort is pretty phenomenal,” Le said in the release. “I really love research, and this project reflects how much care has evolved — and we’re adding to it. I know we’re just at the beginning, but it’s crazy to think that one day maybe hospitals will be using this Shieh scale.” 

What is the Shieh Score?

Created in 2019, the Shieh Score is used to predict which hospitalized patients are “at high risk for pressure injuries,” according to a study published in 2023 in the “Journal of Wound Ostomy & Continence Nursing” (JWOCN). The study, conducted between Jan. 1, 2020, and Dec. 31, 2020, involved a patient assessment, and those who met the criteria for a high-risk pressure injury had a “skin at risk” sign posted in their room. Standard preventive measures for pressure injuries were then implemented. 

“Implementation of the program (Shieh Score, early warning system, and standard order set for preventive interventions) resulted in a 38% reduction in the annual hospital-acquired pressure injury rate from a mean incidence rate of 1.03 to 0.64 hospital-acquired pressure injuries per 1,000 patient-days measured for the year 2020,” the study found. 

The Shieh Score was created on the basis of “retrospective data”. Scores are determined using nine criteria, including sex, age, diabetes, and use of IV norepinephrine. 

Braden Scale vs. Shieh Score for Pressure-Wound Monitoring

The Braden Scale, according to WMU, is the industry standard for determining ulcer risk factors. However, the scoring is subjective. Developed in the late 1980s, the Braden Scale asks practitioners to rate, on a scale of one to four, a patient’s sensory perception, moisture exposure, degree of physical activity, mobility, nutrition, and friction and shear. The scale is used along with a clinical assessment. 

The Shieh Score, according to WMU, would be more objective. 

Dr. Kenneth Olshansky, of Virginia Commonwealth University, argued in a letter responding to the JWOCN-published study that the word “predict” not be used in relation to hospital-acquired pressure injuries (HAPIs). 

“In fact, the Braden Scale doesn’t ‘predict’ risk but ‘identifies’ risk,” he wrote. “In addition, the Braden or any other scale cannot ‘predict’ the development of [pressure injuries] … The scores alert the staff that these patients are at high risk, but it’s up to the staff to implement every means possible to prevent that patient from developing a HAPI.” 

What’s Next for Pressure-Wound Monitoring?

Depending on the study’s results, which hospital leadership will review, the Shieh Score could be used locally and systemwide, according to WMU. 

“The initial data from the students’ research is already so compelling that nursing leadership is excited about the possibilities,” Neuman said. 

Swenson said that because healthcare and nursing alike are “ever-changing,” they are always researching and updating practices. 

“I like seeing this new scale and seeing how well it’s working so far … I’m really excited to see where this goes and see how it’s implemented into this hospital and possibly throughout the country,” Swenson said.

The Bottom Line

WMU nursing students are involved in research at a Michigan hospital system to improve pressure-wound monitoring in the hospital setting. Their work involves the Shieh Score, a newer approach that was developed in 2019 and said to be more objective than the industry standard Braden Scale. Based on a hospital leadership review of the students’ data, the Shieh Score could be implemented both locally and systemwide. 

Read More