An examination of how nurses use the Waterlow Scale for judgement and decision making in continuing care

Abstract

Using an information processing approach, this study examines how nurses working in the area of continuing care for older people in Scotland use the Waterlow scale to inform their judgement and decision making in risk of pressure ulcers and plan of care. While assessment tools are commonly used, a number of assumptions surround their use for nurse practice and for patient care. To date, there appears to be no research which actually examines how nurses use assessment tools to assess patient's needs and plan care, despite the emphasis placed on evidence based practice. Assessment is a fundamental activity when caring for an older person where multipathology and the potential for health state deterioration are likely. This study consists of 3 parts. Part 1 identified the number and type of assessment tools that are routinely used within continuing care settings using a postal survey, revealing that the Waterlow scale is the most routinely used tool to assess pressure ulcer risk. Part 2 examined how continuing care nurses assess pressure ulcer risk through the use of observation and interview. Part 3 involved a detailed examination of the cognitive processes used by nurses when assessing pressure ulcer risk and planning care using simulation and a technique known as `Think aloud'. The results of this study indicate there were no differences between continuing care nurses working in either hospital wards or nursing homes in how the assessment was carried out, as neither group based their assessment or plan of care solely on the Waterlow scale. However, the Waterlow scale was found to be used differently according to the nurses' experience with those with more than 2 years experience, less likely to base their assessment of pressure ulcer risk or plan of care on Waterlow derived information.