The Norton Scale was developed in 1962 by Norton, McLaren, and Exton-Smith during a study of geriatric nursing problems. Low scores on this scale indicate high risk. All 3 tools provide a method of systematic, quantitative assessment, and multidisciplinary team communication. Only mobility and activity are scored on all 3 instruments. The Braden Scale has good reliability and better predictive validity than has been reported for the Norton and Gosnell Scales.
Optimal prediction occurs when ongoing assessments are made.
Each patient is to be assessed for pressure ulcer risk at admission, after 48 hours, weekly for the first month, at least quarterly after that, and as the condition changes in long-term care. For acute care, assessments are to be performed by the nurses upon admission, again weekly, and then with a change in condition. Under certain circumstances, pressure alone will result in a pressure ulcer, even in healthy, viable tissue. Pressure synergistically combines with other factors to increase the chance for pressure ulcer development. No scale, however sophisticated, can be more than an indicator of risk.