Impact of a Visualization Training Platform on PICU Nurses' Pain Assessment Skill in Critically Ill Children: A Mixed‐Methods Randomized Controlled Trial

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ABSTRACT Aims Pain is common and challenging to assess in the paediatric intensive care unit (PICU), highlighting the need for targeted training. We previously developed PainScan, a visualization‐based training platform and aimed to investigate the efficacy of PainScan in improving PICU nurses' pain assessment competencies and to describe their learning experience with PainScan. Design This study employed a mixed‐methods design, integrating a superiority, randomized parallel controlled trial with embedded qualitative research. The RCT component of this study was prospectively registered at ClinicalTrials.gov (NCT06431802) prior to participant enrollment. Methods Eligible PICU nurses from a tertiary children's hospital in Shanghai, China, took part in the trial. 70 PICU nurses were recruited and randomly assigned to either the PainScan training group or the on‐site training group using stratified randomization, with 35 individuals in each group, over 4 weeks. Primary outcomes were PICU nurses' knowledge and skill levels in pain assessment. Outcome assessors were blinded to group allocation. Following the training, a descriptive qualitative study was conducted using semi‐structured interviews with 11 PICU nurses, who had participated in PainScan training, to gain insights into their learning experience. Results A total of 69 participants (35 in the PainScan group, 34 in the on‐site training group) were included in the primary outcome analysis, as one participant (1.4%) in the on‐site training group withdrew due to a rotation change. Both PainScan training and on‐site training significantly improved PICU nurses' knowledge (PainScan: t = 10.249, on‐site: t = 10.592, both p < 0.001) and skill levels in pain assessment (PainScan: Z = −5.138, on‐site: Z = −4.847, both p < 0.001). Compared to traditional on‐site training, the PainScan showed superior skill development ( Z = −3.644, p < 0.001). Qualitative findings revealed that the platform: (1) competency enhancement in pain assessment through PainScan training; (2) advantages of the digital learning platform; and (3) limitations of the PainScan training. Conclusion PainScan effectively enhanced PICU nurses' pain assessment competencies. It also enriched their learning experience through a realistic, immersive and flexible approach. However, improvements are needed in supervision, engagement and scalability. Reporting Methods The randomized controlled trial was reported according to CONSORT 2025, and the qualitative component was reported following COREQ. Patient or Public Contribution This study shows that PainScan is a practical and cost‐effective training tool for PICU nurses. It can enhance pain assessment skills with flexible learning. Addressing feedback on supervision and engagement could further optimize its use in clinical practice to improve patient care.