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Norton Scale: Assessing Pressure Ulcer Risk

The Norton Scale is a nursing assessment tool used to evaluate a patient´s risk of developing pressure ulcers. It scores five criteria to help identify at-risk individuals early.

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Things worth knowing about "Norton Scale"

The Norton Scale is a nursing assessment tool used to evaluate a patient´s risk of developing pressure ulcers. It scores five criteria to help identify at-risk individuals early.

What is the Norton Scale?

The Norton Scale is a standardized assessment tool used in nursing and clinical medicine to evaluate a patient´s risk of developing a pressure ulcer (also known as a bedsore or decubitus ulcer). It was developed in 1962 by British nursing researcher Doreen Norton and remains one of the most widely used pressure ulcer risk assessment instruments in both inpatient and community care settings.

Pressure ulcers develop when sustained pressure on specific areas of the body interrupts blood flow, leading to tissue damage. They are most common in immobile, elderly, or seriously ill patients.

Structure and Scoring

The Norton Scale assesses five categories, each scored on a scale from 1 to 4:

Physical condition: From very bad (1) to good (4)
Mental condition: From stuporous (1) to alert (4)
Activity: From bedfast (1) to ambulant (4)
Mobility: From immobile (1) to full (4)
Incontinence: From always incontinent (1) to continent (4)

The total score ranges from 5 to 20 points. The lower the score, the higher the risk of pressure ulcer development:

14–20 points: Low or no risk
10–13 points: Medium risk
5–9 points: High risk

Clinical Application

The Norton Scale is typically applied upon admission to a hospital or care facility and is reassessed regularly to detect changes in a patient´s risk profile. It forms the basis for planning pressure ulcer prevention measures, which may include:

Regular repositioning of the patient
Use of pressure-relieving aids (e.g., specialized mattresses, positioning cushions)
Skin care and moisture management
Nutritional support to promote tissue perfusion

Further Developments

Over time, the Norton Scale has been refined to improve its predictive accuracy. A well-known adaptation is the modified Norton Scale, which adds criteria such as nutritional status and skin condition. Other commonly used pressure ulcer risk assessment tools include the Braden Scale and the Waterlow Scale.

Limitations of the Norton Scale

Despite its widespread use, the Norton Scale has certain limitations. It does not capture all relevant risk factors, such as skin moisture, friction, or nutritional status, which are addressed in more recent assessment tools. Nevertheless, it remains an important and practical instrument in clinical nursing practice.

References

Norton D., McLaren R., Exton-Smith A. N. - An Investigation of Geriatric Nursing Problems in Hospital. Churchill Livingstone, Edinburgh, 1962.
European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPIAP) - Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. 2019.
Bergstrom N., Braden B. J., Laguzza A., Holman V. - The Braden Scale for Predicting Pressure Sore Risk. Nursing Research, 36(4), 205-210, 1987.

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