Introduction: With the rapid integration of Artificial Intelligence (AI) in healthcare, it is essential for nurses to possess foundational knowledge and preparedness to work with AI-based tools. In Southern Punjab, Pakistan, there is limited understanding of nurses’ AI literacy, attitudes, and readiness for implementation. Objective: To assess the knowledge, perceptions, and acceptance of AI among registered nurses in Southern Punjab. Methodology: A descriptive cross-sectional study was conducted among 60 registered nurses. Data were gathered using a structured, close-ended questionnaire and analyzed using SPSS version 25 to evaluate participants’ knowledge levels and perceptions regarding the use of AI in clinical practice. Results: Among the 60 participants, 80% were female, and 50% held a BSc Nursing degree. None of the respondents reported receiving formal training in AI. Only 14.6% acknowledged the potential role of AI in nursing practice, while 94% opposed its inclusion in the nursing curriculum. Despite these limitations, 60% of participants expressed willingness to receive AI training in the future, and 55% believed AI could eventually improve patient care quality if implemented properly. Furthermore, 83.3% of respondents were working in hospital settings, which may influence their exposure and adaptability to new technologies. Conclusion: This study reveals a substantial gap in AI knowledge and training among nurses in Southern Punjab. While current understanding and acceptance levels are low, the willingness to learn presents an opportunity. Institutional efforts such as targeted training programs, workshops, and curriculum reforms are critical to equipping the nursing workforce for a technology-driven future in healthcare.
Artificial Intelligence (AI) is transforming the healthcare sector through innovative applications such as intelligent monitoring systems, predictive analytics, and diagnostic imaging, which improve clinical decision-making and healthcare efficiency (Topol, 2019). As frontline healthcare professionals, nurses play a crucial role in implementing these technologies in clinical settings. The American Nurses Association (2021) emphasizes the importance of equipping nurses with essential digital competencies to effectively work with AI-based systems.
Previous studies have shown that nurses’ knowledge and awareness significantly influence healthcare practices and patient outcomes. Research conducted among critical care nurses in South Punjab highlighted that adequate knowledge and positive attitudes are essential for improving patient care quality (Mulazim et al., 2025). Similarly, awareness of emerging innovations and novel treatments among nurses is important to ensure that healthcare professionals remain updated with modern medical advancements (Shabir et al., 2025). In addition, studies have reported that nurses’ knowledge is crucial for safe medication administration and reducing clinical errors in healthcare settings (Din et al., 2025).
Workplace challenges such as burnout and occupational health hazards may also affect nurses’ professional performance and their ability to adopt new technologies (Majeed et al., 2025; Ahmad et al., 2025). Despite the growing use of artificial intelligence in healthcare worldwide, its integration into nursing practice remains limited in low-resource regions such as Southern Punjab, Pakistan. Therefore, assessing nurses’ knowledge regarding artificial intelligence is important to identify educational gaps and support the effective adoption of AI technologies in healthcare.
Need for AI Literacy in Nursing
There is growing global recognition of the need for AI literacy among healthcare professionals. Studies have shown that a lack of awareness, limited exposure to digital technologies, and insufficient training contribute to resistance or reluctance in adopting AI (Davenport & Kalakota, 2019; Graziani et al., 2023). In nursing specifically, AI literacy encompasses understanding how AI systems work, evaluating their relevance in clinical scenarios, and navigating ethical challenges related to their use (Frith, 2019; Ng et al., 2022).
In their survey, Abdullah and Fakieh (2020) revealed that healthcare professionals' acceptance of AI is closely tied to their perceived competence and institutional support. In Pakistan’s evolving healthcare landscape, most nurses are not adequately prepared to engage with AI due to limited curricular integration and a lack of professional development opportunities (Ronquillo et al., 2021). This results in gaps in digital readiness that could hinder safe and effective AI adoption.
Barriers to AI Adoption in Low-Resource Settings
Southern Punjab exemplifies many of the systemic barriers seen in low- and middle-income countries (LMICs). These include inadequate internet infrastructure, limited access to modern medical equipment, and insufficient training on digital health tools. Boillat et al. (2021) noted that digital health literacy remains alarmingly low in many LMICs, limiting healthcare professionals' ability to use advanced technologies. Additionally, Elsayed and Sleem (2021) pointed out that nurse managers often express concerns about job displacement, loss of clinical autonomy, and data security.
The perceptions and readiness of nurses must be addressed through targeted educational reforms and institutional support. Educational institutions should incorporate AI concepts into nursing curricula, and healthcare organizations must invest in capacity building to improve digital competencies. Gaughan et al. (2022) emphasized that digital transformation in healthcare is more likely to succeed when staff feel supported and involved in implementation processes.
Rationale for the Study
The significance of studying how nurses assess AI knowledge stems from its profound ramifications for the future of healthcare delivery, particularly in rapidly evolving technological landscapes like Pakistan. Since nurses are at the forefront of healthcare delivery, their expertise and use of AI technologies are crucial to patient care. First and foremost, this research is significant since it helps close the gap between the theoretical comprehension and practical implementation of AI in healthcare settings. Healthcare organizations can identify areas where educational and training programs should be improved by assessing nurses' proficiency with AI concepts and technologies. This will help ensure that nurses have the skills necessary to employ AI to improve patient outcomes.
Literature Review
There are several barriers preventing nurses from learning about AI. The absence of instructional materials and training programs that are geared toward their unique requirements is a significant obstacle (Johnson et al., 2021). Additionally, the quick pace of technological change in AI makes it challenging for nurses to keep up with the most recent developments (James & Brown, 2018). Additionally, it is challenging to incorporate AI education into nursing courses due to institutional limitations, financial constraints, and conflicting priorities (Garcia et al., 2022). The quality and safety of patient treatment might suffer if nurses are not adequately knowledgeable about artificial intelligence. Without adequate training, nurses may struggle to utilize AI technologies efficiently for tasks such as individualized treatment planning, predictive analytics, and decision support (Chen & Wang, 2023). This negates the potential benefits of AI in enhancing patient outcomes (Lee et al., 2021) and raises the risk that AI-generated insights will be misused and misunderstood.
Addressing the gaps in nurses' knowledge of AI necessitates a multifaceted approach. It is imperative to develop unique AI training programs that are specific to the duties and responsibilities of nurses (Robinson et al., 2020). These programs should include both theoretical understanding of AI principles and practical instruction on how to use AI tools in clinical settings. Partnerships between academia, healthcare institutions, and technology companies can help develop thorough AI curricula (Wu et al., 2022). Furthermore, continuous professional development opportunities and support networks may help nurses keep abreast of changes in AI and boost their confidence in utilizing AI technologies (Tan et al., 2023). The integration of AI into healthcare has unparalleled potential for transforming nursing practice and improving patient outcomes. However, in order to realize these benefits, nurses must have a strong command of AI knowledge and skills. In order to ensure that nurses are equipped to utilize the full potential of AI in delivering superior patient care, targeted education and training programs are crucial.
The term "artificial intelligence" (AI) describes a new way of thinking that is similar to that of people. Combining a variety of cutting-edge technologies like natural language processing, machine learning, and computer vision, artificial intelligence is a system. According to Sheikh et al. (2021), artificial intelligence (AI) is a relatively new technology that is sometimes seen as a "black box." The objective is to complete activities that require human intelligence, such as pattern identification, decision-making, and speech recognition. The World Economic Forum defines artificial intelligence (AI) as "act by sensing, interpreting data, learning, reasoning, and recommending." Nevertheless, this categorization is intricate and multifaceted; it addresses a variety of social, ethical, legal, and technological topics, but there is no universally accepted definition.
This study used a descriptive cross-sectional research design to assess nurses’ knowledge, perceptions, and acceptance of artificial intelligence in nursing practice. This study was conducted in different healthcare settings across Southern Punjab, including both public and private hospitals and clinical facilities, to ensure diversity among participants. The target population consisted of registered nurses who were actively working in clinical and hospital environments. A total of 60 nurses participated in the study and were selected through non-probability convenience sampling. This method allowed easy access to participants but may limit the generalizability of the results. Data were collected using a structured close-ended questionnaire adapted from a validated tool developed by Abdullah Abuzaid (2022), ensuring reliability and content validity. The questionnaire included sections on demographic characteristics and questions assessing nurses’ knowledge, perceptions, and acceptance of artificial intelligence. Data collection was completed over one month after obtaining written informed consent from all participants. Participation was voluntary, and confidentiality and anonymity were maintained throughout the study. The overall study duration was from January 1, 2026, to March 1, 2026. Data were analyzed using IBM SPSS Statistics. Descriptive statistics, including frequencies and percentages, were used to summarize the results. Independent variables included age, gender, educational level, years of experience, and work setting, while dependent variables included knowledge, perception, and acceptance of artificial intelligence in nursing. Knowledge scores were categorized as excellent (>80%), good (65–80%), average (50–65%), and poor (<50%).
Demographic Characteristics
A total of 60 registered nurses took part in the study. The sample was predominantly female (80%), with males representing 20%. The largest age group was 30–39 years (36.7%), followed by participants aged 20–29 (30%), 40–49 (20%), 50–59 (10%), and over 60 years (3.3%).
Regarding educational qualifications, 50% of respondents held a Bachelor’s degree in Nursing, 33.3% had a diploma in nursing, and 16.7% possessed a Master’s degree. In terms of work experience, 33.3% reported having 6–10 years of experience, 28.3% had between 11 and 20 years, 25% had 0–5 years, while 13.3% had over 20 years of professional experience. The majority (83.3%) were employed in hospital settings, with the remaining 16.7% working in clinics (Table 01).
Table 01: Demographic Characteristics of Study Participants (N = 60)
|
Variable |
Category |
Frequency (n) |
Percentage (%) |
|
Gender |
Male |
12 |
20.0% |
|
|
Female |
48 |
80.0% |
|
Age Group |
20–29 years |
18 |
30.0% |
|
|
30–39 years |
22 |
36.7% |
|
|
40–49 years |
12 |
20.0% |
|
|
50–59 years |
6 |
10.0% |
|
|
Above 60 years |
2 |
3.3% |
|
Education |
Diploma |
20 |
33.3% |
|
|
BSc Nursing |
30 |
50.0% |
|
|
MSc Nursing |
10 |
16.7% |
|
Experience |
0–5 years |
15 |
25.0% |
|
|
6–10 years |
20 |
33.3% |
|
|
11–20 years |
17 |
28.3% |
|
|
Above 20 years |
8 |
13.3% |
|
Work Setting |
Hospital |
50 |
83.3% |
|
|
Clinic |
10 |
16.7% |
Table 4.2: The curriculum should include at least some basic knowledge of AI
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
The curriculum should include at least some basic knowledge of AI |
Strongly disagree |
24 |
39.3 |
4.16 |
0.984 |
|
disagree |
30 |
49.3 |
|||
|
Neutral |
3 |
5.3 |
|||
|
Agree |
4 |
6.0 |
|||
|
Strongly agree |
0 |
0 |
|||
|
|
Total |
60 |
100.0 |
|
|
Table 4.2 presents the results about “The curriculum should include at least some basic knowledge of AI”. According to data, majority of respondents are disagreed with the given statement. Mean score 4.16 with 0.984 standard deviation that fall in criterion of acceptance.
Table 4.3: AI should be taught in the undergraduate program.
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
AI should be taught in the undergraduate program. |
Strongly disagree |
24 |
40.0 |
4.19 |
0.797 |
|
disagree |
33 |
55.4 |
|||
|
Neutral |
1 |
1.3 |
|||
|
Agree |
2 |
3.3 |
|||
|
Strongly agree |
0 |
0 |
|||
|
|
Total |
60 |
100.0 |
|
|
Table 4.3 presents the results about “AI should be taught in the undergraduate program.”. According to data, majority of respondent are disagreed with the given statement. Mean score 4.19 with 0.797 standard deviation that fall in criterion of acceptance.
Table 4.4: AI should be taught in the postgraduate program.
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
AI should be taught in the postgraduate program |
Strongly disagree |
24 |
40.7 |
4.24 |
0.917 |
|
disagree |
32 |
53.3 |
|||
|
Neutral |
0 |
0.7 |
|||
|
Agree |
3 |
5.3 |
|||
|
Strongly agree |
0 |
0 |
|||
|
|
Total |
60 |
100.0 |
|
|
Table 4.4 shows results that “AI should be taught in the postgraduate program’s”. Results of table shows that 94.0% of respondents are agree and 0.7% are undecided and 5.3% are disagree to the statement. Mean score is 4.24 with standard deviation. Mean score falls in criterion to acceptance the statement.
Table 4.5: I have a basic understanding of AI.
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
I have a basic understanding of AI. |
Strongly disagree |
31 |
52.0 |
4.52 |
0.501 |
|
disagree |
29 |
48.0 |
|||
|
Neutral |
0 |
0 |
|||
|
Agree |
0 |
0 |
|||
|
Strongly agree |
0 |
0 |
|||
|
|
Total |
60 |
100.0 |
|
|
Table 4.5 presents the results about “I have a basic understanding of AI.”. According to data, 100% respondent are disagreed with the given statement. Mean score 4.52 with 0.501 standard deviation that fall in criterion of acceptance.
Table 4.6: I have a working knowledge of AI
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
I have a working knowledge of AI. |
Strongly disagree |
26 |
42.7 |
4.43 |
0.496 |
|
disagree |
34 |
57.3 |
|||
|
Neutral |
0 |
0 |
|||
|
Agree |
0 |
0 |
|||
|
Strongly agree |
0 |
0 |
|||
|
|
Total |
423 |
100.0 |
|
|
Table 4.6 presents the result about “I have a working knowledge of AI.”. According the data, 100% respondent are disagreed. The mean score is 4.43 with 0.496 standard deviation that fall in criterion of acceptance. This explores that Ineffective use of computer in classes.
Table 4.7: I have been trained and educated about AI.
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
I have been trained and educated about AI |
Strongly disagree |
28 |
46.0 |
4.46 |
1.224 |
|
disagree |
32 |
54..0 |
|||
|
Neutral |
0 |
0 |
|||
|
Agree |
0 |
0 |
|||
|
Strongly agree |
0 |
0 |
|||
|
|
Total |
60 |
100.0 |
|
|
Table 4.7 presents the results about nurses’ view regarding the item “I have been trained and educated about AI.”. According to data, 100% respondent are disagreed. The mean score is 4.46 with 0.500 standard deviation that falls in criterion of acceptance.
Table 4.8: AI plays an important role in nursing.
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
AI plays an important role in nursing. |
Strongly disagree |
8 |
14.0 |
3.55 |
1.207 |
|
disagree |
35 |
58.7 |
|||
|
Neutral |
6 |
10.7 |
|||
|
Agree |
9 |
14.6 |
|||
|
Strongly agree |
1 |
2.0 |
|||
|
|
Total |
60 |
100.0 |
|
|
Table 4.8 presents the result about the nurses’ view regarding the item “AI plays an important role in nursing.”. According to the data, 72.7% respondent are disagreed, 0.7% are undecided, and 6.6% are disagree to the statement. The mean score is 3.55 with .207 standard deviation that falls in criterion of acceptance.
Table 4.9: AI will take place in many nursing applications and practices.
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
AI will take place in many nursing applications and practices. |
Strongly disagree |
24 |
40.0 |
4.40 |
0.492 |
|
disagree |
36 |
60.0 |
|||
|
Neutral |
0 |
0 |
|||
|
Agree |
0 |
0 |
|||
|
Strongly agree |
0 |
0 |
|||
|
|
Total |
60 |
100.0 |
|
|
Table 4.9 presents the result about the nurses’ views regarding the item “AI will take place in many nursing applications and practices.”. According the data 100% respondents are disagreed to the statement. The mean value is 4.40 and 0.492 standard deviation that fall in criterion acceptance.
Table 4.10: AI will threaten/disrupt the nursing practice.
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
AI will threaten/disrupt the nursing practice. |
Strongly disagree |
27 |
45.3 |
4.45 |
0.499 |
|
disagree |
33 |
54.7 |
|||
|
Neutral |
0 |
0 |
|||
|
Agree |
0 |
0 |
|||
|
Strongly agree |
0 |
0 |
|||
|
|
Total |
60 |
100.0 |
|
|
Table 4.10 presents the results of nurses views about “AI will threaten/disrupt the nursing practice.”. According to data, 100% respondent are disagreed to the statement. The mean score is 4.45with 0.499 standard deviation that fall in the criterion of acceptance.
Table 4.11: AI will threaten/disrupt the nursing career.
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
AI will threaten/disrupt the nursing career. |
Strongly disagree |
32 |
52.7 |
4.47 |
0.501 |
|
Disagree |
28 |
47.3 |
|||
|
Neutral |
0 |
0 |
|||
|
Agree |
0 |
0 |
|||
|
Strongly agree |
0 |
0 |
|||
|
|
Total |
60 |
100.0 |
|
|
Table 4.11 presents the result of nurses views about “AI will threaten/disrupt the nursing career.”. According to the data 100% respondent are disagreed. The mean score is 4.47 with 0.501 standard deviation that falls in criterion of acceptance.
Table 4.12: AI has no limitation in my work.
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
AI has no limitation in my work. |
Strongly disagree |
8 |
14.0 |
3.55 |
1.207 |
|
disagree |
35 |
58.7 |
|||
|
Neutral |
6 |
10.7 |
|||
|
Agree |
9 |
14.6 |
|||
|
Strongly agree |
1 |
2.0 |
|||
|
|
Total |
60 |
100.0 |
|
|
Table 4.12 presents the result about the nurses’ view regarding the item “AI has no limitation in my work.”. According to the data, 72.7% respondent are disagreed, 0.7% are undecided, and 6.6% are disagree to the statement. The mean score is 3.55 with .207 standard deviation that falls in criterion of acceptance.
Table 4.13: I use modern audio-visual aids to teach their subjects.
|
Statement |
|
f |
Percentage |
Mean |
S.D. |
|
I use modern audio-visual aids to teach their subjects. |
Strongly disagree |
30 |
50.7 |
4.51 |
0.502 |
|
Disagree |
30 |
49.3 |
|||
|
Neutral |
0 |
0 |
|||
|
Agree |
0 |
0 |
|||
|
Strongly agree |
0 |
0 |
|||
|
|
Total |
60 |
100.0 |
|
|
Table 4.13 presents the result of nurses’ view about I use modern audio-visual aids to teach their subjects. According to the data 100% respondent are disagreed. The mean of the data is 4.51 and 0.502 is standard deviation that falls in criterion of acceptance.
Despite their limited exposure to AI, a small proportion (14.6%) believed that AI could have a useful role in nursing practice. However, a substantial majority (85.4%) were either unsure or disagreed with its usefulness, indicating uncertainty or skepticism.
Additionally, 94% of participants disagreed with the idea of integrating AI-related content into nursing undergraduate or postgraduate curricula, while only a few showed interest in such inclusion.
While none of the participants reported using AI in their current clinical settings, the results revealed a degree of openness toward learning, especially if structured training programs were provided. Importantly, none of the respondents believed that AI poses a threat to the nursing profession, which suggests a non-defensive attitude and potential willingness to adapt in the future.
In low-resource areas like Southern Punjab, Pakistan, this study reveals a troubling gap in the integration of artificial intelligence (AI) into nursing education. In other similar settings, infrastructural constraints and outmoded curricula prevent the use of new technology in healthcare environments. Participants' total lack of formal AI training is consistent with this (Boillat et al., 2021; von Gerich et al., 2022). The majority of participants indicated that they were open to receiving future AI training, notwithstanding the high rate of opposition (94%) to integrating AI into nursing education. Reflecting findings from earlier studies that a lack of exposure frequently results in uncertainty or scepticism (Abuzaid, 2022; Castagno & Khalifa, 2020), this tension is probably caused by unfamiliarity rather than active resistance.
Only 14.6% of nurses thought AI was beneficial to their field, which is interesting since it indicates that they have a poor understanding of how AI can enhance clinical decision-making, simplify procedures, and improve patient outcomes. As Buchanan et al. (2020) and Robert (2019) noted, AI is revolutionizing every aspect of nursing practice, including documentation, diagnostics, patient monitoring, and care planning. Nevertheless, nurses are still ill-equipped to actively engage in digital transformation programs unless they have a solid understanding and confidence in these tools. This mirrors similar trends observed worldwide, where frontline healthcare workers frequently lack digital literacy and AI preparedness (Ronquillo et al., 2021; Lambert et al., 2023).
Even though they had reservations, none of the respondents believed that AI posed a danger to the nursing industry. Concerns expressed in Western contexts, where there are frequently fears that AI would replace nursing positions, stand in contrast to this conclusion (Watson et al., 2020). In contrast, the Pakistani nurses in this study seem more open to using AI as long as they receive sufficient assistance. This non-defensive stance offers a chance for focused initiatives aimed at increasing knowledge, demystifying AI, and encouraging nurse-led innovation. According to numerous studies, organized training greatly enhances nurses' acceptance of technology (Schwendimann et al., 2020; Gaughan et al., 2022).
The broader literature emphasizes the importance of integrating AI into both undergraduate nursing education and continuing professional development (American Nurses Association, 2021; Frith, 2019). Doing so would not only prepare nurses for modern clinical environments but also ensure their roles evolve in tandem with technological advancements. AI-powered tools; such as clinical decision support systems, predictive analytics for patient deterioration, and chatbot-assisted triage; are becoming increasingly common in hospitals (Cho et al., 2023; Laukka et al., 2022). Without foundational competence in these systems, nurses risk being sidelined in interdisciplinary care teams or reduced to peripheral roles in data-driven healthcare delivery.
Moreover, qualitative research conducted worldwide (Gao et al., 2020; Ng et al., 2022) demonstrates that nurses frequently cherish humanistic care and worry that AI may dehumanize relationships. Designing AI systems that complement human interaction in nursing, rather than replace it, is necessary to allay such worries. By automating administrative tasks, for instance, AI can free up nurses' time to provide direct patient care, which can increase job satisfaction and lower burnout (Huhtala et al., 2021).
In Pakistan, where digital infrastructure remains underdeveloped in many regions, institutional support is crucial. Leadership buy-in, investment in faculty training, and partnerships with tech developers are essential for building sustainable AI literacy among nurses (Sodeau & Fox, 2022; Sheikh et al., 2023). Policies must also ensure equitable access to training resources so that nurses in rural or resource-constrained areas are not left behind.
In conclusion, this study sheds light on a critical need for systemic reform in nursing education and capacity building. Integrating AI-related content into nursing curricula, supported by institutionally backed learning opportunities and interprofessional collaboration, is essential for creating future-ready nurses. As emphasized by Topol (2019), the goal is not to replace nurses with machines, but to empower them with intelligent tools that elevate care quality. Moving forward, a multi-stakeholder approach involving educators, policymakers, healthcare leaders, and technologists will be vital in translating this vision into reality.
This study exposes a critical AI knowledge deficit among Southern Punjab nurses, rooted in systemic gaps in education and infrastructure. Yet, their non-resistant attitudes suggest readiness for change, provided interventions address contextual barriers (e.g., resource limitations, curricular inertia).
Recommendations
Based on the results of this study, the following recommendations are proposed to improve Artificial Intelligence (AI) awareness and integration among nursing professionals in Southern Punjab, Pakistan:
This study exposes a critical AI knowledge deficit among Southern Punjab nurses, rooted in systemic gaps in education and infrastructure. Yet, their non-resistant attitudes suggest readiness for change, provided interventions address contextual barriers (e.g., resource limitations, curricular inertia).
Recommendations
Based on the results of this study, the following recommendations are proposed to improve Artificial Intelligence (AI) awareness and integration among nursing professionals in Southern Punjab, Pakistan: