A Nurse-Centered Socio-Technical Readiness Framework for Artificial Intelligence in Clinical Practice

Authors

  • Placide Mutabazi Office of the Executive Chancellor, Open Christian University, Sacramento, United States Author
  • Sixbert SANGWA Department of International Business and Trade, African Leadership University, Kigali, Rwanda Author

DOI:

https://doi.org/10.65655/OpenChristianPress.2026.117

Keywords:

nursing, Artificial intelligence, AI readiness, digital health, clinical decision support, socio-technical systems, nursing ethics, technology acceptance, patient safety, AI governance

Abstract

Background: Artificial intelligence (AI) is moving from experimental promise into the everyday infrastructure of clinical work through predictive analytics, clinical decision support, remote monitoring, documentation automation, robotics, and increasingly generative AI. Nurses are central to this transition because they translate data-rich systems into bedside decisions, relational care, safety surveillance, patient advocacy, and ethical accountability. Yet the literature shows that nurses’ AI preparedness remains uneven, with readiness shaped not only by literacy and training but also by workflow fit, explainability, professional autonomy, equity, and governance. Aim: This article develops a nurse-centered socio-technical framework for AI readiness in clinical practice and clarifies why preparing nurses for AI requires more than digital skills acquisition. Design: Critical integrative review and conceptual framework development. Evidence base: The synthesis integrates recent empirical nursing studies, systematic and qualitative reviews, nursing position statements, health AI reporting standards, and global AI governance guidance. Priority was given to peer-reviewed sources published from 2018 to 2026, supplemented by foundational theories of technology acceptance, socio-technical systems, nursing ethics, and human factors. Synthesis: Six interdependent readiness domains were identified: technical, educational, ethical/legal, professional, organizational, and equity/governance readiness. These domains explain why AI adoption may fail even when systems are technically sophisticated and why nurse participation in design, implementation, oversight, and evaluation is indispensable. Conclusion: AI readiness in nursing is best understood as a socio-technical capability distributed across persons, technologies, institutions, regulations, and moral relationships. AI should augment, not displace, the nurse’s clinical judgment, relational presence, and professional responsibility. Impact: The proposed framework offers nurse educators, clinical leaders, health system executives, AI developers, regulators, and researchers a practical structure for designing, evaluating, and governing AI-enabled nursing practice without weakening the human core of care.

References

American Academy of Nursing. (2026). American Academy of Nursing position statement on artificial intelligence in health care. Nursing Outlook. Advance online publication. https://www.nursingoutlook.org/article/S0029-6554(26)00098-9/fulltext

American Nurses Association. (2022). The ethical use of artificial intelligence in nursing practice. https://www.nursingworld.org/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/the-ethical-use-of-artificial-intelligence-in-nursing-practice_bod-approved-12_20_22.pdf

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T

Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19-32. https://doi.org/10.1080/1364557032000119616

Booth, R. G., Strudwick, G., McBride, S., O'Connor, S., & Solano López, A. L. (2021). How the nursing profession should adapt for a digital future. BMJ, 373, n1190. https://doi.org/10.1136/bmj.n1190

Char, D. S., Shah, N. H., & Magnus, D. (2018). Implementing machine learning in health care: Addressing ethical challenges. New England Journal of Medicine, 378(11), 981-983. https://doi.org/10.1056/NEJMp1714229

Collins, G. S., Moons, K. G. M., Dhiman, P., Riley, R. D., Beam, A. L., Van Calster, B., Ghassemi, M., Liu, X., Reitsma, J. B., van Smeden, M., Boulesteix, A.-L., Camaradou, J. C., Celi, L. A., Denaxas, S., Denniston, A. K., Glocker, B., Golub, R. M., Harvey, H., Heinze, G., ... Logullo, P. (2024). TRIPOD+AI statement: Updated guidance for reporting clinical prediction models that use regression or machine learning methods. BMJ, 385, e078378. https://doi.org/10.1136/bmj-2023-078378

Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13(3), 319-340. https://doi.org/10.2307/249008

De Gagne, J. C. (2023). The state of artificial intelligence in nursing education: Past, present, and future directions. International Journal of Environmental Research and Public Health, 20(6), 4884. https://doi.org/10.3390/ijerph20064884

Dixon-Woods, M., Cavers, D., Agarwal, S., Annandale, E., Arthur, A., Harvey, J., Hsu, R., Katbamna, S., Olsen, R., Smith, L. K., Riley, R., & Sutton, A. J. (2006). Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6, 35. https://doi.org/10.1186/1471-2288-6-35

El Arab, R. A., Alshakihs, A. H., Alabdulwahab, S. H., Almubarak, Y. S., Alkhalifah, S. S., Abdrbo, A., Hassanein, S., & Sagbakken, M. (2025). Artificial intelligence in nursing: A systematic review of attitudes, literacy, readiness, and adoption intentions among nursing students and practicing nurses. Frontiers in Digital Health, 7, 1666005. https://doi.org/10.3389/fdgth.2025.1666005

El-Bassal, N. A. M., El-Sayed, A. A. I., & Elgamal, H. G. (2025). Empowering nurses in the AI era: Investigating the interplay between professionalism, AI readiness, and self-efficacy. BMC Nursing, 24, 1287. https://doi.org/10.1186/s12912-025-03896-y

Gianfrancesco, M. A., Tamang, S., Yazdany, J., & Schmajuk, G. (2018). Potential biases in machine learning algorithms using electronic health record data. JAMA Internal Medicine, 178(11), 1544-1547. https://doi.org/10.1001/jamainternmed.2018.3763

Grant, M. J., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26(2), 91-108. https://doi.org/10.1111/j.1471-1842.2009.00848.x

Holden, R. J., & Karsh, B.-T. (2010). The technology acceptance model: Its past and its future in health care. Journal of Biomedical Informatics, 43(1), 159-172. https://doi.org/10.1016/j.jbi.2009.07.002

Holden, R. J., Carayon, P., Gurses, A. P., Hoonakker, P., Hundt, A. S., Ozok, A. A., & Rivera-Rodriguez, A. J. (2013). SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics, 56(11), 1669-1686. https://doi.org/10.1080/00140139.2013.838643

International Council of Nurses. (2023). Digital health transformation and nursing practice. https://www.icn.ch/sites/default/files/2023-08/ICN%20Position%20Statement%20Digital%20Health%20FINAL%2030.06_EN.pdf

Joo, J. Y., Liu, M. F., & Ho, M.-H. (2025). Nurses' perceptions of artificial intelligence adoption in healthcare: A qualitative systematic review. Nurse Education in Practice, 88, 104542. https://doi.org/10.1016/j.nepr.2025.104542

Karimian, G., Petelos, E., & Evers, S. M. A. A. (2022). The ethical issues of the application of artificial intelligence in healthcare: A systematic scoping review. AI and Ethics, 2, 539-551. https://doi.org/10.1007/s43681-021-00131-7

Labrague, L. J., Aguilar-Rosales, R., Yboa, B. C., & Sabio, J. B. (2023). Factors influencing student nurses' readiness to adopt artificial intelligence in their studies and their perceived barriers to accessing AI technology: A cross-sectional study. Nurse Education Today, 130, 105945. https://doi.org/10.1016/j.nedt.2023.105945

Liu, X., Cruz Rivera, S., Moher, D., Calvert, M. J., Denniston, A. K., & the SPIRIT-AI and CONSORT-AI Working Group. (2020). Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: The CONSORT-AI extension. BMJ, 370, m3164. https://doi.org/10.1136/bmj.m3164

Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18, 143. https://doi.org/10.1186/s12874-018-0611-x

National Academy of Medicine. (2025). An artificial intelligence code of conduct for health and medicine: Essential guidance for aligned action. National Academies Press. https://doi.org/10.17226/29087

National Institute of Standards and Technology. (2023). Artificial Intelligence Risk Management Framework (AI RMF 1.0) (NIST AI 100-1). https://doi.org/10.6028/NIST.AI.100-1

Pujari, S., Reis, A., Zhao, Y., Alsalamah, S., Serhan, F., Reeder, J. C., & WHO AI for Health Working Group. (2023). Artificial intelligence for global health: Cautious optimism with safeguards. Bulletin of the World Health Organization, 101(4), 290-215. https://doi.org/10.2471/BLT.23.290215

Ramadan, O. M. E., Alruwaili, M. M., Alruwaili, A. N., Elsehrawy, M. G., & Alanazi, S. (2024). Facilitators and barriers to AI adoption in nursing practice: A qualitative study of registered nurses' perspectives. BMC Nursing, 23, 891. https://doi.org/10.1186/s12912-024-02571-y

Rivera, S. C., Liu, X., Chan, A.-W., Denniston, A. K., Calvert, M. J., Ashrafian, H., Beam, A. L., Collins, G. S., Darzi, A., Deeks, J. J., Eeles, E., Haug, C., Moher, D., Ordish, J., Penzien, J., & the SPIRIT-AI and CONSORT-AI Working Group. (2020). Guidelines for clinical trial protocols for interventions involving artificial intelligence: The SPIRIT-AI extension. BMJ, 370, m3210. https://doi.org/10.1136/bmj.m3210

Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., ... Straus, S. E. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467-473. https://doi.org/10.7326/M18-0850

Vasey, B., Nagendran, M., Campbell, B., Clifton, D. A., Collins, G. S., Denaxas, S., Denniston, A. K., Faes, L., Geerts, B. F., Ibrahim, M., Liu, X., Mateen, B. A., Mathur, P., McCradden, M. D., Morgan, L., Ordish, J., Rogers, C., Saria, S., Ting, D. S. W., ... McCulloch, P. (2022). Reporting guideline for the early-stage clinical evaluation of decision support systems driven by artificial intelligence: DECIDE-AI. BMJ, 377, e070904. https://doi.org/10.1136/bmj-2022-070904

Venkatesh, V., Morris, M. G., Davis, G. B., & Davis, F. D. (2003). User acceptance of information technology: Toward a unified view. MIS Quarterly, 27(3), 425-478. https://doi.org/10.2307/30036540

Wei, Q., Pan, S., Liu, X., Hong, M., Nong, C., & Zhang, W. (2025). The integration of AI in nursing: Addressing current applications, challenges, and future directions. Frontiers in Medicine, 12, 1545420. https://doi.org/10.3389/fmed.2025.1545420

Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546-553. https://doi.org/10.1111/j.1365-2648.2005.03621.x

World Health Organization. (2021). Ethics and governance of artificial intelligence for health: WHO guidance. https://www.who.int/publications/i/item/9789240029200

World Health Organization. (2023). Regulatory considerations on artificial intelligence for health. https://www.who.int/publications/i/item/9789240078871

World Health Organization. (2024). Ethics and governance of artificial intelligence for health: Guidance on large multi-modal models. https://www.who.int/publications/i/item/9789240084759

World Health Organization, & International Council of Nurses. (2025). State of the world's nursing 2025: Investing in education, jobs, leadership and service delivery. https://www.who.int/publications/i/item/9789240110236

Yang, Q., Zhao, M., Yang, L., Wang, X., & Yang, C. (2026). Artificial intelligence readiness and its influencing factors among newly qualified nurses: A cross-sectional study. Frontiers in Medicine, 13, 1753024. https://doi.org/10.3389/fmed.2026.1753024

Zhou, Y., Li, Z., & Li, Y. (2021). Interdisciplinary collaboration between nursing and engineering in health care: A scoping review. International Journal of Nursing Studies, 117, 103900. https://doi.org/10.1016/j.ijnurstu.2021.103900

Downloads

Published

2026-05-14

Issue

Section

Articles

How to Cite

Mutabazi, P., & SANGWA, S. (2026). A Nurse-Centered Socio-Technical Readiness Framework for Artificial Intelligence in Clinical Practice. Open Journal of Transformative Education & Lifelong Learning (ISSN: 3105-305X), 2(2). https://doi.org/10.65655/OpenChristianPress.2026.117

Most read articles by the same author(s)

1 2 > >>