A systematic review of empirical studies synthesized how digital competencies and AI-related constructs are associated with academic performance and learning-related outcomes in nursing education suggests that digital competencies are associated with academic and learning-related outcomes mainly through self-efficacy, academic motivation, cognitive presence, and learning flow.
Abstract
Digital transformation and artificial intelligence are reshaping nursing education by changing how students access information, complete academic tasks, and engage with technology-mediated learning. However, evidence on digital competencies, AI-related constructs, mediating mechanisms, and academic performance remains fragmented and methodologically uneven. This systematic review of empirical studies synthesized how digital competencies and AI-related constructs are associated with academic performance and learning-related outcomes in nursing education. Following PRISMA 2020 guidelines adapted to social science research, searches were conducted in Scopus and Web of Science Core Collection in March 2026, covering 2022–2026. Twenty-five empirical studies were included: 18 quantitative, 4 qualitative, and 3 mixed-methods studies. The evidence was concentrated in the Middle East and North Africa, Asia, and Europe. Findings suggest that digital competencies are associated with academic and learning-related outcomes mainly through self-efficacy, academic motivation, cognitive presence, and learning flow. AI-related evidence remains emerging, mixed, and context-dependent. Although some AI-assisted interventions reported favorable outcomes, one experimental study found greater knowledge gains with traditional text-based study than with ChatGPT-assisted learning. Therefore, AI integration should not be considered universally beneficial, but contingent on pedagogical design, task type, teacher guidance, AI literacy, responsible use, and critical verification.
BACKGROUND
In response to the increasingly demanding needs of healthcare today, the integration of digital technologies into nursing education has accelerated. Digital approaches such as simulation, virtual learning environments, and AI-supported applications have become widely used to improve clinical competence. However, the mechanisms by which they affect learning and their effectiveness in cognitive, psychosocial, and psychomotor domains have not been sufficiently conceptualized.
OBJECTIVE
To integrate the effects of digital-based educational methods on nursing students' learning experiences and to develop a conceptual framework.
DESIGN
An integrative review.
METHOD
This review was conducted in accordance with the Whittemore and Knafl framework. A total of 54 studies published between January 2021 and January 2026, using qualitative, quantitative, and mixed methods, were included in the study. The methodological quality of the study was evaluated using the Mixed Methods Assessment Tool. Data were synthesized through inductive content analysis.
RESULTS
Digital-based intervention results significantly improved psychomotor skill performance, clinical decision-making ability, self-learning, motivation, and professional identity. The findings explain a shift from passive to active learning in the learning process, i.e., digital autonomy. A "Holistic Transformation Model of Digital Clinical Learning" encompassing safe learning spaces, digital autonomy, psychosocial transformation, and hybrid learning ecosystems has been developed.
CONCLUSION
Digital-based training methods represent a transformative pedagogical change in nursing education. Promoting digital autonomy and hybrid learning ecosystems is essential for achieving sustainable clinical competence in contemporary healthcare settings.
Gülçah Sunay Ertem, Sibel Ergun, Serap Kaynak et al.· Nurse Education Today· 0 citations
This study aims to examine the implementation patterns, technology integration, learning outcomes, student engagement, and sustainability factors of blended learning (BL) in health professions education (HPE) between 2020 and 2024 across diverse pedagogical and educational contexts. Despite the increasing adoption of BL in HPE, the existing literature lacks a comprehensive, theory-informed synthesis of implementation patterns, technology integration, the relationship between student engagement and learning outcomes, and sustainability factors across disciplines and educational settings. This study employed a Systematic Literature Review (SLR) following the PRISMA 2020 guidelines. The review was conducted using the Scopus database and included studies published between January 2020 and December 2024. A total of 41 peer-reviewed empirical studies were selected from an initial pool of 65 records through rigorous title and abstract screening, followed by full-text eligibility assessment. Data were synthesised narratively, and the findings were organised thematically according to five research questions using an integrated theoretical framework encompassing constructivism, cognitive load theory, multimedia learning theory, and self-regulated learning theory. The findings revealed that 58.5% of the included studies implemented general BL approaches, whereas 41.5% adopted established pedagogical frameworks. Technology integration primarily involved multimedia resources (53.7%), digital assessment platforms (43.9%), and video conferencing tools (43.9%). Overall, BL demonstrated high effectiveness, with 86% of the reported learning outcome measures indicating positive results. Structured active engagement exhibited the strongest positive association with learning outcomes (r ≈ 0.55–0.75). The main challenges included substantial resource requirements and difficulties in student self-regulation, whereas instructional design support emerged as the most important facilitating factor. These findings suggest that although BL is highly effective in HPE, its long-term sustainability depends on transitioning from ad hoc implementation to institutionally supported, theory-driven instructional design. Accordingly, educators and higher education institutions should prioritise intentional pedagogical design and sustained institutional support to ensure the effective and sustainable implementation of blended learning in health professions education.
Mira Istiana, Eveline Siregar, T. Iriani et al.· Jurnal Paedagogy· 0 citations
The evidence showed that, virtual reality simulations with varying immersive abilities were the most popular innovative educational technology used in undergraduate mental health nursing education and both immersive and non‐immersive VRS were equally effective in improving student learning experiences compared to traditional learning modalities.
Sini Jacob, Sebastian Samuel, Greety Antony et al.· International Journal of Men...· 0 citations
To synthesize evidence on the role of PBL in pre-registration pharmacy education in fostering metacognitive and interpersonal competency development, with particular emphasis on self-regulation, learner autonomy, and professional collaboration.
A systematic search of MEDLINE, Embase, ERIC, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) identified peer-reviewed primary studies exploring PBL-related competency and skill development among undergraduate pharmacy students. Quantitative, qualitative, and mixed methods studies were included. Two reviewers independently screened studies and extracted data. Findings were synthesized narratively, and methodological quality was appraised using the Mixed Methods Appraisal Tool 2018.
Twenty-six studies met the inclusion criteria (12 mixed methods, 11 quantitative descriptive, 3 qualitative). Three domains emerged from the narrative synthesis: (1) Self-regulated clinical reasoning, decision-making, and metacognitive development (
n
= 16); (2) Communication and teamwork skills (
n
= 12); and (3) Engagement, motivation, and learning management skills, including organization and accountability (
n
= 9). Across studies, PBL was associated with enhanced reflective capacity, greater ownership of learning, improved confidence in complex decision-making, and strengthened collaborative communication. However, experiences were not uniformly positive; some studies reported learner anxiety, resistance, or reduced engagement when cultural alignment was limited. Most studies were rated medium to high quality.
Beyond cognitive gains, PBL appears to cultivate self-regulation, learner autonomy, and collaborative competencies essential for preparing pharmacists capable of navigating the evolving scope of contemporary practice. Further longitudinal, theory-informed research is needed to clarify the contextual conditions under which PBL most effectively supports sustained learner development.
Nursing academics appear to adopt AI selectively, prioritising preservation of core professional values while embracing applications perceived to enhance, rather than replace, educational practice, providing evidence for nursing education programs globally regarding faculty development, institutional policy frameworks, and curriculum design strategies integrating technological advancement whilst maintaining person-centred values.
Natasha Hawkins, Anthea Fagan, Yumiko Coffey et al.· Journal of Advanced Nursing· 0 citations