Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 1;23(2):173-181.
doi: 10.1097/ANC.0000000000000968. Epub 2022 Mar 29.

Agreement of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) With NICU Nurses' Assessments

Keri Benbrook  1 , Renee C B Manworren, Rebecca Zuravel, Ashley Entler, Kimberly Riendeau, Catherine Myler, Paige Ricca
Affiliations

Agreement of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) With NICU Nurses' Assessments

Keri Benbrook et al. Adv Neonatal Care. .

Abstract

Background: Objective assessment tools should standardize and reflect nurses' expert assessments. The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) and the Neonatal Infant Pain Scale (NIPS) are valid measures of pain. The N-PASS also provides a sedation subscale.

Purpose: The objective of this study was to determine N-PASS clinical validity and utility by evaluating agreement of N-PASS scores with bedside nurses' assessments of pain/agitation and sedation in a 64-bed tertiary neonatal intensive care unit.

Methods: Fifteen bedside nurses trained to use the N-PASS and the NIPS prospectively completed 202 pain/agitation and sedation assessments from a convenience sample of 88 infants, including chronically ventilated, medically fragile infants. N-PASS and NIPS scores were obtained simultaneously but independently of nurse investigators. Bedside nurses also made recommendations about infants' pain and sedation management.

Results: There was moderate agreement between N-PASS pain scores and nurses' recommendations (κ= 0.52), very strong agreement between N-PASS sedation scores and nurses' recommendations (κ= 0.99), and very strong associations between N-PASS pain and NIPS scores ( P < .001). Bedside nurse and independent investigator interrater reliability was good for N-PASS pain and NIPS scores (intraclass correlation coefficient [ICC] = 0.83, ICC = 0.85) and excellent for N-PASS sedation (ICC = 0.94). During 93% of assessments, bedside nurses reported that the N-PASS reflected the level of infant sedation well or very well.

Implications for practice and research: The N-PASS provides an easy-to-use, valid, and reliable objective measure of pain and sedation that reflects nurses' assessments. Additional studies using the N-PASS are needed to verify results and the influence of the N-PASS on pain and sedation management for medically fragile infants with chronic medical conditions.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Herr K, Coyne PJ, Ely E, Gélinas C, Manworren RCB. Pain assessment in the patient unable to self-report: clinical practice recommendations in support of the ASPMN 2019 Position Statement. Pain Manag Nurs. 2019;20(5):404–417. doi:10.1016/j.pmn.2019.07.005.
    1. Andersen RD, Langius-Eklöf A, Nakstad B, Bernklev T, Jylli L. The measurement properties of pediatric observational pain scales: a systematic review of reviews. Int J Nurs Stud. 2017;73:93–101. doi:10.1016/j.ijnurstu.2017.05.010.
    1. Anand KJ. Pharmacological approaches to the management of pain in the neonatal intensive care unit. J Perinatol. 2007;27(suppl 1):S4–S11. doi:10.1038/sj.jp.7211712.
    1. Giordano V, Edobor J, Deindl P, et al. Pain and sedation scales for neonatal and pediatric patients in a preverbal stage of development: a systematic review. JAMA Pediatr. 2019;173(12):1186–1197. doi:10.1001/jamapediatrics.2019.3351.
    1. Hummel P, van Dijk M. Pain assessment: current status and challenges. Semin Fetal Neonatal Med. 2006;11(4):237–245. doi:10.1016/j.siny.2006.02.004.

LinkOut - more resources