# VALENF-Instrument-Based Nursing Assessment and Early Occurrence of Hospital-Acquired Pressure Injuries and Falls Among Hospitalized Adults

## TL;DR

This study explores how early nursing assessments using the VALENF Instrument can predict pressure injuries and falls in hospitalized adults, with most events occurring within the first five days.

## Contribution

The study introduces the VALENF Instrument as a tool for early risk stratification of pressure injuries and falls in hospitalized patients.

## Key findings

- Most adverse events (63%) occurred within the first five days of hospital admission.
- High-pressure injury risk scores were associated with a nine-fold higher incidence of new injuries.
- Urgent admission increased the risk of pressure injuries by more than six-fold.

## Abstract

Background/Objectives: Pressure injuries and falls are frequent hospital adverse events. Identifying high-risk periods may help guide preventive strategies. In this exploratory study, we aimed to estimate the time from hospital admission to the occurrence of pressure injuries and/or falls and analyze its relationship with the nursing assessment at admission. Methods: A longitudinal observational study was conducted with a systematic sample of 314 adult patients admitted between January and May 2024. Nursing assessment at admission was performed using the VALENF Instrument, which integrates functional capacity, pressure injury risk, and fall risk. Survival analysis was performed to describe the temporal distribution of adverse events and compare their occurrence across nursing assessment variables using the log-rank test. Poisson Generalized Linear Models were applied to explore associated factors. Results: Nineteen adverse events were recorded (15 pressure injuries and 4 falls). Twelve of the 19 total events (63%) occurred within the first five days of admission. Patients with lower functional capacity (log-rank p < 0.001) and high-pressure injury risk (log-rank p < 0.001) according to the VALENF Instrument, showed an earlier occurrence of new pressure injuries in the Kaplan–Meier analysis. Similarly, fall risk scores (log-rank p = 0.037) obtained with the same instrument were associated with falls. Patients classified as high risk for pressure injuries showed an approximately nine-fold higher incidence rate of developing new injuries (Wald χ2, p < 0.001), while urgent admission further increased this risk more than six-fold (Wald χ2, p = 0.015). Conclusions: In this exploratory study with a limited number of events, most adverse events occurred early during hospitalization. The findings suggest that early nursing assessment using the VALENF Instrument may help stratify patients for closer monitoring early in admission, pending confirmation in larger studies.