Isabella DeMarco

06/25/22

NUR 115

Dr. Lisa Shiver

EBP Written Assignment: Neonatal Pain Scales

Infants in the NICU frequently undergo a variety of painful events and procedures. NICU

nurses may struggle with an expansive understanding of neonatal pain assessment and therefore

may lack the knowledge to properly treat their patients. To counteract this, neonatal pain scales

that assist in identifying pain levels in infants are implemented in the clinical practice. The most

common pain scale utilized is the Neonatal Infant Pain Scale (NIPS). However, this scale may

not properly address how to recognize chronic pain in infants. The research study “Comparing

N-Pass and NIPS: Improving Pain Measurements in the Neonate” from the journal Clinical

Issues in Neonatal Care addresses the issue of adequate pain management regarding the neonatal

population. The study introduces a different pain scale: Neonatal Pain, Agitation, and Sedation

Scale (N-PASS) and compares it to the NIPS to determine which is the best to utilize in the

NICU.

This study was conducted in the setting of a teaching hospital’s level IV NICU. The 58

NICU Healthcare providers who participated in the study were asked to complete a pre and post

assessment survey regarding their level of proficiency in assessment of an infant’s pain. In the

pre assessment survey, participants were asked to discuss their comprehension of assessing a

neonate’s pain prior to being taught how to effectively utilize the N-PASS. Following this survey,
the NICU workers were then educated on how to implement the N-PASS during routine pain

assessments. The education was comprehensive and involved a multitude of teaching strategies

in order to ensure effective learning. The educational aspect of the quality improvement study

took place over one month, and all participants were evaluated on their knowledge of neonatal

pain management at the end of the teaching. The nurses then began to implement the N-PASS

into their regular pain assessments in addition to NIPS. The nurses were to utilize both scales at

once to ensure accurate comparisons and recorded all results for one week.

Assessment of an infant for pain differs significantly from assessing an adult and may be

more complicated. This is due to the fact that neonates cannot verbally communicate their pain

levels or if they are in any pain at all. Patients in the NICU are frequently subjected to painful

procedures and as a result can develop acute or chronic pain. If a nurse is improperly trained in

pain assessment of a neonate, this pain can go unnoticed. Exposure to consistent pain levels that

remain untreated at such an integral period of human development can cause various future

mental and physical consequences. It is essential to ensure adequate knowledge of nurses

through proper education and learning tools such as a specific pain scale that can be utilized to

assess a neonate for pain.

The findings from this study were determined via post assessment after a period

implementing the new N-PASS pain scale. The findings relayed that in 98% of the pain scores

recorded, the N-PASS system reported back higher levels of pain than the NIPS system did when

used simultaneously. In addition, the post assessment of the participants' knowledge reflected an

increase in competency after neonatal pain education and implementation of N-PASS. The result

of this study indicated that NIPS is not as effective in measuring acute and chronic pain levels of

infants, and that N-PASS illustrates a specialized level of detecting pain.

 At the hospital where this study was conducted, the N-PASS is now the primary tool

utilized to assess the pain levels of neonates. However; more research is needed to widely

implement N-PASS in clinical practice. Repeat studies including data that examines the

effectiveness of pain assessment tools and chronic versus acute pain need to be done. As of now,

the best policy for nurses is to be properly trained in neonatal pain assessment and have their

knowledge frequently tested to ensure proficiency. Nurses should continue outside research to

understand developments in the clinical practice and be aware that policies may change.

Neonates cannot verbally communicate, and therefore depend on nurses to be able to recognize

and treat their emergent pain. Therefore, it is the responsibility of the nurse to continue to

educate themselves on new clinical developments.

 References

Desai, A., DNP, CRNP, Aucott, S., MD, Frank, K., DNP, APRN-CNS, Silbert-Flagg, J., DNP,

CRNP, et al. (2018). Comparing N-PASS and NIPS: Improving Pain Measurement in the

Neonate. Advances in Neonatal Care. 18, 260-266.

https://doi.org/10.1097/ANC.0000000000000521