Psychometric Evaluation of the Neonatal Pain, Agitation, and Sedation Scale (n-Pass) Tool in Infants and Children Age One to Thirty-Six Months in the Post-Anesthesia Care Unit

The purpose of this study was to investigate the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) tool for evidence of validity and reliability in infants and children aged one to thirty-six months in the Post-Anesthesia Care Unit (PACU). This study design was a prospective, non-experimental psychometric evaluation of the N-PASS tool. The research was conducted at a Midwestern Medical Center. The sample analyzed comprised forty subjects aged one to thirty-six months. Data collection involved the evaluation of participants every five minutes, utilizing the N-PASS sedation subscale along with the University of Michigan Sedation Scale (UMSS) and the N-PASS pain/agitation subscale along with the Face, Legs, Arms, Cry, Consolability (FLACC) tool. All subjects were observed for a minimum of ten observations. The results showed that the Cronbach\u27s alphas of the N-PASS sedation scale ranged from .853 to .923, and from .935 to .971 for the N-PASS pain/agitation scale. Correlations between the N-PASS sedation scale and the UMSS tool ranged from .847 to .967. Correlations between the N-PASS pain/agitation scale and the FLACC tool ranged from .980 to .996. Repeated Measures ANOVA analysis revealed that the N-PASS sedation score decreased linearly over time. Repeated Measures ANOVA indicated that the N-PASS pain/agitation scores changed over time, but not at a linear, quadratic, or cubic form. Regression analysis revealed a statistically non-significant linear trend for the prediction of amount of time spent in PACU as a function of change in sedation levels from time 1 to time 10. Principal axis factor analysis found that two factors accounted for 80.46 to 87.77% of the variance. One factor represented pain/agitation, and one factor represented sedation, confirming the two subscales of the N-PASS tool. All items had high factor loadings (\u3e .60). Factor structure remained similar over the three time periods. The implications for this research indicate sufficient evidence for use of the N-PASS tool for sedation and pain/agitation assessment in infants and children one to thirty-six months of age