# Neonatal intensive care nurses’ assessment of preterm infants’ pain and sedation: inter-rater reliability of the neonatal pain, agitation, and sedation scale

## TL;DR

This study evaluates how consistently NICU nurses and researchers assess pain and sedation in preterm infants using the N-PASS scale.

## Contribution

The study provides insights into inter-rater reliability of N-PASS among NICU nurses and researchers.

## Key findings

- Moderate-to-good reliability was found for the pain/agitation subscale of N-PASS.
- Nurses assigned higher mean pain/agitation scores compared to researchers.
- Sedation subscale showed excellent or moderate reliability based on ICC values.

## Abstract

Timely and accurate assessment of pain and sedation in newborns is essential for effective management. Therefore, neonatal pain and sedation assessment remains a key global issue in neonatal intensive care unit (NICU) nursing practice. This study examined the inter-rater reliability of Neonatal Pain Agitation, and Sedation Scale (N-PASS) scores among NICU patients.

This prospective observational study assessed agreement among 19 NICU nurses and two independent researchers who completed 190 observations from 82 preterm infants. Each evaluator rated N-PASS independently and blindly. Agreement among three raters—a nurse and two researchers—were analyzed using the intraclass correlation (ICC) and the Fleiss kappa test.

Agreement levels varied across N-PASS subscales. The ICC and kappa values indicated moderate-to-good reliability for the pain/agitation subscale, whereas the ICC values for the sedation subscale indicated excellent or moderate reliability. Nurses assigned higher mean pain/agitation scores than researchers.

NICU nurses must improve their N-PASS assessment skills for both pain and sedation. NICU nurse managers should prioritize improving these competencies to improve pain experiences and ensure adequate sedation, given their significant impact on short- and long-term outcomes in preterm infants.