Effects of a generative AI-assisted ADPIE Framework on critical thinking, learning self-efficacy, and clinical reasoning in nursing education: a quasi-experimental study

Abstract

The nursing process is a systematic, patient-centered framework essential for clinical reasoning and decision-making in nursing education. It is commonly operationalized through the ADPIE (Assessment, Diagnosis, Planning, Implementation, and Evaluation) model, which guides nurses in identifying patient needs, developing care plans, implementing interventions, and evaluating outcomes in a structured and iterative manner. Although the nursing process is fundamental to nursing education and practice, some students may experience difficulties in applying ADPIE effectively, particularly the aspects of clinical reasoning and reflective practice. This was a quasi-experimental study conducted to compare the effects of a Generative Artificial Intelligence (GenAI)-assisted nursing process approach with traditional instruction on nursing students’ evidence-based critical thinking, learning self-efficacy, and self-reported clinical reasoning. Moreover, the study integrated the intervention into a second-year nursing course (i.e., nursing process via obstetric nursing internship) as part of formal curriculum activities. Students who participated in the GenAI-assisted nursing process approach demonstrated higher levels of evidence-based critical thinking, improved learning self-efficacy, and enhanced self-reported clinical reasoning ability compared with those in the traditional instruction group. The GenAI system provided adaptive feedback, real-time scaffolding, and iterative case refinement beyond traditional case-based learning. Integrating GenAI into the ADPIE framework within nursing education may enhance students’ critical thinking, learning self-efficacy, and self-reported clinical reasoning by supporting structured and reflective learning processes, offering a promising pedagogical approach for nursing education.