Association of artificial intelligence literacy with moral distress and moral resilience among nursing interns: A...

Artificial intelligence (AI) is increasingly integrated into healthcare and nursing education, requiring new forms of digital competency among nursing interns. However, the associations of AI literacy with ethical and psychological outcomes among nursing interns remain unclear. This study examined the associations of AI literacy with moral distress and moral resilience among nursing interns.

This cross-sectional study included 300 nursing interns from three tertiary hospitals in China between December 2025 and April 2026. AI literacy was assessed using the 12-item AI Literacy Scale adapted by Reinhardt et al. Moral distress and moral resilience were assessed using the Moral Distress Scale-Revised and the Rushton Moral Resilience Scale, respectively. Multivariable linear regression models and exploratory subgroup analyses were performed.

The mean (SD) age of the participants was 22.0 (1.2) years, 234 (78.0%) were female, and the mean (SD) AI literacy score was 3.98 (1.29). Higher AI literacy was associated with lower moral distress in both the unadjusted model (β = -0.64; 95% CI, -0.73 to -0.55; P < .001) and adjusted model (β = -0.63; 95% CI, -0.72 to -0.54; P < .001). Higher AI literacy was also associated with greater moral resilience in both the unadjusted model (β = 0.74; 95% CI, 0.66 to 0.82; P < .001) and adjusted model (β = 0.74; 95% CI, 0.66 to 0.81; P < .001). These associations were generally consistent across participant subgroups.

In this cross-sectional study, higher AI literacy was associated with lower moral distress and higher moral resilience among nursing interns. These findings suggest that AI literacy may be an important correlate of ethical adaptation during clinical training and warrant confirmation in longitudinal studies.