What is Each Subscale of the Braden Scale?

Pressure injuries, also known as pressure ulcers or bedsores, are a significant concern in home care. When working with patients in their homes, the environment can vary widely, and proactive assessment is key. One of the most reliable tools used to evaluate a patient's risk for developing pressure injuries is the Braden Scale. Developed in the 1980s, this assessment tool remains widely used in home health settings due to its effectiveness and simplicity.

The Braden Scale consists of six subscales, each evaluating a different factor that contributes to skin breakdown. Scoring on this scale helps guide interventions to protect vulnerable individuals. For those providing care outside of traditional clinical settings, understanding each of these subscales can improve outcomes and enhance patient safety in everyday routines. This article explores each component of the Braden Scale in detail and discusses how it applies in a home care setting.

Sensory Perception

The first subscale evaluates a patient's ability to sense discomfort or pain due to pressure on their skin. Sensory perception is foundational in identifying who is most at risk for pressure injuries. When a person can’t feel discomfort or is unable to communicate it effectively, they may remain in one position too long, increasing their risk.

In the home setting, this becomes especially relevant when caring for individuals with neurological conditions, diabetes, or those recovering from strokes. It’s not uncommon for someone to sit in a recliner or lie in bed for long periods without shifting, simply because they don’t realize they need to move. Assessments should include asking whether the patient can feel pressure or discomfort and observing whether they respond when prompted to move.

Practical interventions include scheduled repositioning, pressure-relieving cushions, and skin checks. For those with limited sensation, technology integrated into home care software can prompt timely repositioning reminders and document patient responses, supporting consistent care.

Moisture

Moisture refers to the degree to which skin is exposed to wetness. This could come from incontinence, sweating, or wound drainage. Prolonged exposure to moisture makes the skin more fragile and more likely to break down.

This subscale is particularly significant when working with patients who are incontinent or have wound exudate. In the home, caregivers might not always notice when a patient’s clothes or linens become damp, especially if the individual doesn’t express discomfort.

Preventing moisture-related damage involves regular toileting schedules, barrier creams, absorbent pads, and breathable clothing. Using absorbent underpads and making sure patients stay dry, especially overnight, can drastically lower risk. Documenting patterns of incontinence or moisture presence using software for home care helps track and address problems early.

Activity

This subscale evaluates the patient’s general physical activity. Are they bedbound? Chairbound? Do they walk occasionally or regularly? Activity level directly impacts circulation and the risk of prolonged pressure in certain areas of the body.

In home care, many clients are limited in mobility. Some may spend most of their time in a bed or wheelchair, while others might walk with assistance. Regular movement helps prevent pressure injuries, but it’s also important to be realistic—many clients aren’t capable of frequent repositioning without help.

Encouraging any form of movement is beneficial, whether it’s standing for a few minutes during television commercials, brief strolls using a walker, or passive range-of-motion exercises. Tracking this through daily notes and planning consistent routines can make a measurable difference.

Mobility

Mobility and activity are often confused, but they measure different things. Mobility refers to the ability to change body position independently. A person could be inactive yet still capable of repositioning themselves in bed. Alternatively, someone might be active when helped but completely unable to reposition without assistance.

This subscale is a strong indicator of how much intervention a patient will need to stay safe. In the home, it’s not always realistic to have someone available every hour to reposition a person, especially overnight. That’s why assessing true mobility is so important—knowing when and how a patient can help themselves informs the care plan.

Mobility also influences the type of equipment used. Hospital beds, trapeze bars, slide sheets, and low-friction garments can all support repositioning. Monitoring how often the patient moves independently versus with assistance provides clarity on risk and helps ensure appropriate support is provided.

Nutrition

The nutrition subscale assesses whether the patient is getting adequate nutrients to maintain skin integrity. Protein, vitamins, and hydration all play significant roles in preventing breakdown. Malnourished individuals are more likely to develop wounds and slower to heal from them.

In home care, poor nutrition is often overlooked. A client may report eating three meals a day, but those meals might lack the necessary nutrients. Denture issues, cognitive decline, or limited finances can all impact food choices and intake. Family caregivers may not realize that a diet of white bread and canned soup doesn’t support healing.

Assessment includes reviewing food diaries, checking weight trends, and discussing any chewing or swallowing issues. Coordination with a dietitian can be helpful, and offering protein supplements or encouraging hydration can go a long way. It’s important to respect the patient’s preferences while finding ways to support better nutrition in subtle, achievable ways.

Friction and Shear

This subscale evaluates the amount of assistance needed when moving, and the degree to which sliding occurs during transfers. Friction refers to the skin rubbing against a surface, while shear occurs when layers of skin move in opposite directions, such as when a patient slides down in bed.

In the home, this is a frequent issue, especially for patients using recliners or adjustable beds. If the head of the bed is elevated too high without proper body support, the patient can slide downward, creating shear stress on their sacrum and heels. This often leads to deep tissue injuries that are hard to detect early.

To mitigate friction and shear, caregivers can use draw sheets, transfer boards, and friction-reducing gloves. Keeping the head of the bed at a safe angle, using positioning wedges, and ensuring the patient isn’t “slumping” during transfers can make a significant difference. Training family caregivers on proper techniques is just as important as using the right tools.

Scoring the Braden Scale

Each subscale is scored from 1 to 4, except for friction and shear, which is scored from 1 to 3. The lower the total score, the higher the risk. A total score of 18 or less usually indicates a risk for pressure injuries.

In home care, this scoring system helps create individualized care plans. A patient scoring low in moisture and nutrition, for example, will require a different approach than one with deficits in mobility and sensory perception. The scale not only identifies risk but also helps prioritize interventions based on the most vulnerable areas.

It’s good practice to reassess patients regularly—weekly for those at higher risk, or after any significant change in condition. Changes in mobility, appetite, or cognition can rapidly affect skin integrity, and being proactive can prevent larger issues down the line.

Applying the Braden Scale in the Home

What makes using the Braden Scale in a home environment unique is the balance between medical assessment and adapting to the home setting. Unlike hospitals, homes don’t always have clinical beds, high-tech mattresses, or 24/7 staff. But what homes do have is familiarity, comfort, and often, consistent routines.

Using the Braden Scale in this setting means making it practical. Can the patient reposition in their favorite recliner? Are they able to reach the commode in time, or do they need a bedside option? Is their diet both appealing and nutritionally adequate? These questions bring the Braden Scale to life, guiding decisions that make sense for each specific home and person.

One helpful method is to incorporate Braden assessments into visit routines. Instead of treating it as a formal “test,” it can become part of everyday observation. Noticing dry skin, damp clothing, missed meals, or decreased participation in transfers are all signs that warrant documentation and intervention.

Educating Caregivers and Families

Another important part of applying the Braden Scale is involving the people closest to the patient. Family caregivers often want to help but may not know what to look for. Teaching them to recognize signs of pressure on the skin, to encourage movement, or to ensure the patient is dry and well-nourished can extend the benefits of professional visits throughout the week.

Simple checklists, visual aids, and clear language can go a long way. The Braden Scale isn’t just a tool for clinicians—it can empower families when explained in practical, actionable terms. It’s not about memorizing scores but about understanding risk factors and how to respond to them.

Conclusion

Understanding each subscale of the Braden Scale provides a well-rounded approach to preventing pressure injuries in home care settings. By assessing sensory perception, moisture, activity, mobility, nutrition, and friction/shear, caregivers can develop targeted strategies that address specific risks for each individual.