Dear Editor,

We wish to thank Hai-Yan Shi and Hong Lin Chen for taking the time to respond to our article, "Evaluation of a Modified Version of the Norton Scale for Use as a Pressure Injury Risk Assessment Instrument in Critical Care," from the May/June 2020 issue of the Journal of Wound, Ostomy, and Continence Nursing.

Calibration power was not undertaken, and we assert it is not essential to complete this analysis for the purpose and scope of this study. Predictive validity was limited to an analysis of the nurses' ability to accurately identify a standard very high-risk patient in a simulated environment. This presents a number of limitations, which were disclosed in the original publication.

You indicated "additional validation and testing of the Optimized Norton Scale is needed" before it can be labeled valid and reliable for use in the critical care setting. We recommend validation in multiple simulated scenarios incorporating a range of risk levels, testing in the clinical practice setting, testing across multiple sites, and/or among a larger sample of critical care nurses. Expanding the study scope may warrant calibration power, and the author welcomes the opportunity for Hai-Yan Shi and colleagues to do so, should their current study deem it beneficial.

Again, we appreciate your thoughtful comments.

Sincerely,

Rhonda Sullivan, DNP, PhD, MSN, MBA, CWON, LNCC

Jacksonville, Florida