An AI/generative AI-assisted blended learning intervention for nursing undergraduates: a quasi-experimental study of attitudes toward AI, AI literacy, and autonomous learning competency

Abstract Background Artificial intelligence (AI) is increasingly shaping healthcare, highlighting the need for nursing graduates to develop relevant competencies. However, structured AI education remains limited in nursing programs, and evidence on the effects of AI-focused teaching interventions remains scarce. Methods A quasi-experimental pretest–posttest study was conducted among 142 undergraduate nursing students at a university in southwestern Zhejiang, China. Seventy-two students participated in a 10-week AI/generative AI (GenAI)-assisted blended learning course comprising 12 h of self-paced online learning and 6 h of hands-on workshops, while 70 students received standard instruction. Attitudes toward AI, AI literacy, and autonomous learning competency were assessed before and immediately after the intervention using validated instruments. Post-test outcomes were compared using analysis of covariance (ANCOVA), adjusting for the corresponding baseline score, previous AI training experience, frequency of AI use, and digital literacy. Results In the intervention group, AI literacy increased significantly from 55.67 ± 9.84 to 65.01 ± 8.81 ( P < 0.001), as did attitudes toward AI, which increased from 48.07 ± 6.77 to 51.72 ± 9.90 ( P = 0.049). Neither outcome changed significantly in the control group. After adjustment for covariates, the intervention group had significantly higher post-test scores for AI literacy (adjusted mean difference = 11.01, 95% CI 8.55–13.47; P < 0.001) and attitudes toward AI (adjusted mean difference = 4.60, 95% CI 1.98–7.21; P < 0.001). Autonomous learning competency changed little in the intervention group ( P = 0.578) but declined significantly in the control group ( P < 0.001). The adjusted post-test difference also favored the intervention group (adjusted mean difference = 10.94, 95% CI 7.44–14.43; P < 0.001). Conclusions AI/GenAI-assisted blended teaching was associated with higher AI literacy and more favorable attitudes toward AI, while autonomous learning competency remained relatively stable in the intervention group but declined in the control group. Structured AI education integrating conceptual learning, practical application, and responsible AI use may be a valuable addition to undergraduate nursing education.