Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




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's 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 (> .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.

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