Methodological Appraisal of the Munro Scale: Psychometric Properties and Diagnostic Accuracy in Adult Surgical Patients: A Methodological Study

Background: Pressure injuries during the perioperative period can adversely affect postoperative outcomes and patient recovery. An essential component of prevention and patient care is systematic risk assessment. The Munro Pressure Ulcer Risk Assessment Scale is a perioperative-specific tool designed to evaluate patients' risk for pressure injuries, enabling early identification of high-risk individuals and facilitating timely preventive interventions by perioperative nurses. Aim: This methodological study aimed to evaluate the validity, reliability, and diagnostic Accuracy of the Munro Pressure Ulcer Risk Assessment Scale (Munro Scale) in adult patients undergoing surgery. Method: This methodological study was conducted on a sample of 200 adult surgical patients from October 2024 to May 2025. Data were collected using the Munro Pressure Injury Risk Assessment Scale alongside a demographic questionnaire. The scale underwent a rigorous process of translation and cultural adaptation following established methodological standards. Psychometric testing encompasses evaluations of content validity, construct validity, and Cronbach's alpha coefficient. Result: Out of 200 surgical patients, 37 (18.5%) developed pressure injuries, mostly classified as Stage I and Stage II. Confirmatory factor analysis (CFA) was conducted using AMOS to evaluate the construct validity of the scale, which included three latent factors: preoperative, intraoperative, and postoperative risk factors. Factor loadings for most items exceeded 0.4, indicating acceptable item relevance. Reliability analysis showed Cronbach's alpha values of 0.84, 0.62, and 0.83 for the preoperative, intraoperative, and postoperative factors, respectively. Composite reliability (CR) values were 0.83, 0.71, and 0.82, confirming acceptable internal consistency. Conclusion: The Munro Scale demonstrated acceptable reliability and validity, confirmatory factor analysis indicating a moderate or limited fit. This scale can be used to assess the risk of pressure injuries in perioperative patients.