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

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Albayrak S., KAN ÖNTÜRK Z., Sen E., Yayla M.

FRONTIERS IN PEDIATRICS, cilt.13, 2026 (SCI-Expanded, Scopus) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 13
  • Basım Tarihi: 2026
  • Doi Numarası: 10.3389/fped.2025.1639511
  • Dergi Adı: FRONTIERS IN PEDIATRICS
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, Directory of Open Access Journals
  • Acıbadem Mehmet Ali Aydınlar Üniversitesi Adresli: Evet

Özet

Background 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.Methods 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.Results 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.Conclusions 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.