Norton Scale
Norton Scale for Pressure Sore Risk Assessment · Also known as: Norton Pressure Sore Risk Scale, NPSRS
The Norton Scale is a pioneering risk assessment tool developed by Doreen Norton and colleagues in 1962 to identify hospitalized patients at risk of developing pressure sores. As one of the earliest standardized pressure ulcer risk assessment instruments, the Norton Scale predates and influenced many later tools including the widely used Braden Scale. It remains relevant in clinical practice, particularly in geriatric and long-term care settings.
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When to use it
Apply the Norton Scale upon admission to healthcare facilities, particularly for elderly patients, those with mobility restrictions, or those with multiple comorbidities. It is especially valuable in geriatric settings, rehabilitation units, and long-term care facilities. Reassess periodically and when significant changes in patient status occur.
Strengths & limitations
- One of the first validated pressure ulcer risk assessment tools with historical significance
- Examines multiple dimensions of patient vulnerability beyond just physical factors
- Relatively quick and easy to administer in clinical settings
- Includes assessment of mental status, an often-overlooked risk component
- Good predictive validity, particularly in older adult populations
- Less sensitive than later tools like the Braden Scale in predicting pressure ulcer development
- Some subscales are subjective and require clinical judgment, potentially leading to scoring variability
- Does not account for nutritional status, a known risk factor for pressure ulcer development
- May be less effective in predicting risk in specialized populations (e.g., critically ill patients)
Frequently asked
What is the difference between the Norton Scale and Braden Scale?
While both assess pressure ulcer risk, the Braden Scale includes nutritional status and friction/shear, which the Norton Scale omits. The Braden Scale also has stronger predictive validity in many populations. However, the Norton Scale's inclusion of mental state assessment can be valuable in geriatric care.
Is a Norton Score of 16 considered high risk?
Generally, a Norton Score of 16 is borderline. Many guidelines recommend preventive interventions for scores of 14 or below. Scores of 14-16 warrant heightened vigilance and protective measures, particularly for elderly patients or those with additional risk factors.
How does the Norton Scale account for nutrition?
The Norton Scale does not have a separate nutrition subscale. Nutritional status is sometimes reflected indirectly in the physical condition score, but this is less systematic than in tools like the Braden Scale, which explicitly assesses nutrition.
Can the Norton Scale be used in acute care settings?
Yes, the Norton Scale can be used in acute care, though it was originally developed for geriatric populations. For critically ill patients, tools like the Braden Scale may have better predictive validity, but Norton remains appropriate for general hospital populations.
Sources
- Norton, D., McLaren, R., & Exton-Smith, A. N. (1962). An investigation of geriatric nursing problems in hospital. National Corporation for the Care of Old People, London. link ↗
- Bergstrom, N., Demuth, P. J., & Braden, B. J. (1987). A clinical trial of the Braden Scale for predicting pressure sore risk. Nursing Clinics of North America, 22(2), 417-428. DOI: 10.1016/s0029-6465(22)01289-0 ↗
How to cite this page
ScholarGate. (2026, June 3). Norton Scale for Pressure Sore Risk Assessment. ScholarGate. https://scholargate.app/en/nursing/norton-scale
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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