The cognitive and ethical crossroads: a qualitative study of academic integrity, emotional landscapes, and generative AI integration in nursing education

AIM: To explore undergraduate nursing students’ experiences and subjective perceptions regarding the integration of AI tools into their academic and professional development. BACKGROUND: The rapid integration of Artificial Intelligence (AI) into education presents a paradigm shift for nursing. A significant gap exists in understanding the lived experiences of nursing students navigating AI integration in their academic journey. METHODS: A qualitative descriptive design using reflexive thematic analysis was employed. DESIGN: A purposive sample of 27 nursing students (levels 4–8) with prior AI experience participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis. RESULTS: Seven major themes emerged: (1) AI as an Adaptive Learning Companion; (2) Tension Between Efficiency and Authentic Learning, manifesting as cognitive offloading and academic integrity ambiguities; (3) Reconceptualizing Professional Nursing Identity, challenging traditional epistemology; (4) Critical Information Literacy and Epistemic Vigilance; (5) Social Dynamics and Peer Learning Cultures; (6) Emotional Landscape of AI Integration, encompassing frustration, empowerment, and anxiety; and (7) Developmental Trajectories showing progressive sophistication and curricular gaps. A post-hoc theoretical integration derived from thematic analysis positioned the efficiency-authenticity tension as the central organizing construct. CONCLUSIONS: AI integration in nursing education is a complex phenomenon. Students demonstrated critical thinking while navigating institutional ambiguity and ethical uncertainty. Findings underscore the urgent need for proactive critical AI literacy integration into nursing curricula, fostering environments to ethically harness AI to augment the essential humanistic core of nursing practice. CLINICAL RELEVANCE: This study underscores that while AI serves as a powerful adaptive learning companion, its integration into nursing practice requires cultivating critical AI literacy and ethical vigilance to ensure technology augments, rather than diminishes, clinical judgment and the humanistic care essential for patient safety. CLINICAL TRIAL NUMBER: Not applicable.