Nurse Education in Practice 75 (2024) 103888

Contents lists available at ScienceDirect

Nurse Education in Practice

journal homepage: www.elsevier.com/locate/issn/14715953

The ChatGPT effect and transforming nursing education with generative AI:
Discussion paper
Lucija Gosak c, *, 1, Lisiane Pruinelli b, 2, Maxim Topaz a, Gregor Štiglic c, d, e, 3
a
Columbia University School of Nursing, New York City, NY, USA
b
College of Nursing and College of Medicine, University of Florida, Gainesville, FL, USA
c
Faculty of Health Sciences, University of Maribor, Maribor 2000, Slovenia
d
Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor 2000, Slovenia
e
Usher Institute, University of Edinburgh, Edinburgh EH8 9YL, UK

A R T I C L E I N F O A B S T R A C T

Keywords Aim: The aim of this study is to present the possibilities of nurse education in the use of the Chat Generative Pre-
Artificial Intelligence training Transformer (ChatGPT) tool to support the documentation process.
ChatGPT Background: The success of the nursing process is based on the accuracy of nursing diagnoses, which also
Documentation
determine nursing interventions and nursing outcomes. Educating nurses in the use of artificial intelligence in the
Education
nursing process can significantly reduce the time nurses spend on documentation.
Nursing
Nursing Diagnosis Design: Discussion paper.
Methods: We used a case study from Train4Health in the field of preventive care to demonstrate the potential of
using Generative Pre-training Transformer (ChatGPT) to educate nurses in documenting the nursing process
using generative artificial intelligence. Based on the case study, we entered a description of the patient’s con­
dition into Generative Pre-training Transformer (ChatGPT) and asked questions about nursing diagnoses, nursing
interventions and nursing outcomes. We further synthesized these results.
Results: In the process of educating nurses about the nursing process and nursing diagnosis, Generative Pre-
training Transformer (ChatGPT) can present potential patient problems to nurses and guide them through the
process from taking a medical history, setting nursing diagnoses and planning goals and interventions. Gener­
ative Pre-training Transformer (ChatGPT) returned appropriate nursing diagnoses, but these were not in line
with the North American Nursing Diagnosis Association – International (NANDA-I) classification as requested. Of
all the nursing diagnoses provided, only one was consistent with the most recent version of the North American
Nursing Diagnosis Association – International (NANDA-I). Generative Pre-training Transformer (ChatGPT) is still
not specific enough for nursing diagnoses, resulting in incorrect answers in several cases.
Conclusions: Using Generative Pre-training Transformer (ChatGPT) to educate nurses and support the docu­
mentation process is time-efficient, but it still requires a certain level of human critical-thinking and fact-
checking.

1. Introduction et al., 2023). Different artificial intelligence-supported chatbot tech­

nologies can be used in problem-based learning to provide practical
ChatGPT has the potential to make a significant contribution to the experience for nurses (Tam, et al., 2023). One such area of nurse edu­
future of nursing education by facilitating learning, promoting improved cation is the nursing process. The nursing process is patient-centered and
digital literacy of users and fostering critical thinking (Castonguay, systematic, with five sequential steps: assessment, diagnosis, planning,

* Corresponding author.
E-mail addresses: [email protected] (L. Gosak), [email protected] (L. Pruinelli), [email protected] (M. Topaz), [email protected]
(G. Štiglic).
1
Twitter: @LucijaGosak
2
Twitter: @LPruinelli
3
Twitter @GStiglic

https://doi.org/10.1016/j.nepr.2024.103888
Received 5 November 2023; Received in revised form 10 December 2023; Accepted 23 December 2023
Available online 10 January 2024
1471-5953/© 2024 Elsevier Ltd. All rights reserved.
L. Gosak et al. Nurse Education in Practice 75 (2024) 103888

implementation and evaluation (Toney-Butler and Thayer, 2022). Generative Pre-training Transformer (ChatGPT) (Patel, Lam, 2023) in
Nursing process adherence is essential for safe and cost-effective nursing helping nurses in assigning nursing diagnoses and providing guidance in
care (Asmirajanti et al., 2019; Zamanzadeh, et al., 2015). To achieve planning the nursing process, including coding nursing outcomes and
that, nurses must describe, record and evaluate the entire nursing pro­ interventions. We present the following sections: (1) case study
cess (Taghavi Larijani and Saatchi, 2019). It is important that the terms description, (2) generative artificial intelligence description, (3) results
and concepts used by nurses are standardized for nursing diagnoses, and (4) discussion and implications for nursing practice.
interventions and outcomes, thus providing a common language for
communication (Shin, et al., 2021). 3. Methods
New technologies can help nurses to improve documentation, which
might help to better describe the patient, capture care processes and In the scope of the Erasmus+ project (a program for education,
eventually improve patient outcomes. This represents an important training, youth and sport in Europe) »Improving healthcare students’
opportunity for us to use novel generative artificial intelligence solu­ competencies for behavior change to effectively support self-care in
tions that could help reduce nurses’ workload and act as a supporting chronic diseases« (https://www.train4health.eu/), several case studies
tool (Hendrich, et al., 2008). have been developed for educational purposes. To demonstrate auto­
mated documentation of the nursing process using generative artificial
2. Background intelligence, we used one of the Train4Health case studies titled »Maria
José«. Based on the case study of Maria José (Annex 1), we entered the
Nursing diagnoses represent the basis of care in the nursing process, description of her condition into Generative Pre-training Transformer
yet there are still debates about the accurate use of nursing diagnoses in (ChatGPT) to formulate further questions. Fig. 1
nursing practice (Seçer and Karaca, 2021). Identifying and describing Based on a study by Irving, et al. (2017), the average consultation
the patient’s problems, signs and symptoms is essential for high-quality with a nurse, where patients such as Maria José is seen, lasts 5 minutes
patient care (Park and Jeong, 2022). Identifying appropriate nursing or less. Due to the heavy load of patients needing care, nurses often do
diagnoses based on an assessment of the patient’s condition is a task that not use nursing diagnoses in their treatment plan, or their treatment
requires nurses’ critical thinking. A nursing diagnosis helps nurses plan is deficient. The excessive workload for nurses, especially in the
describe the patient’s problems or signs/symptoms, which facilitates the form of time pressure, has the effect of reducing the nurse’s attention
selection of targeted nursing interventions (Håkans, 2012). The North span, which in turn increases the potential for errors while delivering
American Nursing Diagnosis Association – International (NANDA-I) patient care (Carayon & Gurses, 2008). Artificial intelligence applica­
defines a nursing diagnosis as a clinical judgment about the patient’, tions use computational algorithms to simulate intelligent behavior and
family’, or community’s response to an actual or potential health thinking comparable to a human being (Malik, et al., 2019). Some
problem (Toney-Butler and Thayer, 2022). The Nursing Intervention common examples of artificial intelligence applications in healthcare
Classification, a comprehensive classification of nursing treatments or include using artificial intelligence for diagnosing diseases, prescribing
interventions, can be used in several ways to represent nursing con­ drugs, improving communication, transcribe medical documents and
structs (De Cordova et al., 2010). The Nursing Intervention Classifica­ treating patients remotely (Basu, et al., 2020). Artificial intelligence
tion includes physiological and psychosocial disease treatments, disease enables nurses to support clinical decision-making in direct patient care,
prevention and health promotion, which can be applied to individuals such as documentation processes (Seibert, et al., 2021). Generative
and families (Bulechek, et al., 2012). Measurable patient outcomes in Pre-training Transformer (ChatGPT) is an artificial intelligence chatbot
response to nursing interventions are needed to determine the effec­ trained on a large amount of information (Lubowitz, 2023). ChatGPT
tiveness of nursing interventions, which can be performed by applying was created by OpenAI and is based on the Generative Pretrained
the Nursing Outcomes Classification, which is used to assess the reli­ Transformer, a large language model trained with 175 billion parame­
ability, validity and utility of nursing interventions, representing a ters. Large language models are developed using natural language pro­
continuum of care (Daly, et al., 1997; Maas, et al., 2002). Standardized cessing techniques to model the probability distribution of a sequence of
nursing outcomes and their evaluation enable effective quality moni­ words or phrases (Floridi and Chiriatti, 2020; Kleesiek, et al., 2023).
toring of nursing care (Lee, 2007). Generative Pre-training Transformer (ChatGPT) has the potential to help
Documentation is perceived as a burdensome task and the time spent healthcare professionals in reducing administrative work via automated
on documentation varies between different countries. For example, in summarization of patient information. It can provide case summaries or
Canada nurses spend 26% of their time on documentation and in the care plans that define care interventions (Scerri and Morin, 2023). Fig. 2
United States, up to 41% (De Groot, et al., 2022; Roumeliotis, et al., presents the proposed approach of using the artificial intelligence tool
2018; Schenk, et al., 2017; Yen, et al., 2018). Increased time spent with we have developed as a recommendation for clinical practice.
patients has shown improved patient outcomes, reduced errors and
increased patient and nurse satisfaction (Westbrook, et al., 2011). In 4. Results
practice, nurses face many challenges in implementing the nursing
process, such as misunderstanding the importance of the process, dif­ North American Nursing Diagnosis Association – International
ferences in attitudes toward the nursing process and nurses’ lack of (NANDA-I) classification by providing the description for the case study
awareness (Zamanzadeh, et al., 2015). Changes in technology (including patient. We posed the following question: “Could you please provide
artificial intelligence) and work processes within the organization and nursing diagnoses following the NANDA-I classification based on the
the unit can significantly improve nurses’ time spent on documentation case study of the patient Maria José?” Based on the question, Generative
(Hendrich, et al., 2008). Various artificial intelligence solutions, such as Pre-training Transformer (ChatGPT) highlighted the following di­
deep learning, have been devised in recent years, usually evolving into agnoses: Risk for Cardiovascular Disease (NANDA-I code: 00146), Risk
functional solutions for clinical practice (La Salvia, et al., 2022). How­ for Impaired Respiratory Function (NANDA-I code: 00032), Ineffective
ever, artificial intelligence-supported tools are not free of erroneous Health Maintenance (NANDA-I code: 00078), Risk for Activity Intoler­
outcomes, especially with the introduction of generative artificial in­ ance (NANDA-I code: 00093), Risk for Impaired Skin Integrity (NANDA-
telligence, where new content is generated by artificial intelligence (Jo, I code: 00046), Risk for Infection (NANDA-I code: 00004), Risk for
2023). To resolve this issue of misinformation by artificial intelligence, Impaired Physical Mobility (NANDA-I code: 00085) and Risk for
nurses need to evaluate artificial intelligence thoroughly before inte­ Depression (NANDA-I code: 00198). It should be noted that Generative
grating it into practice. Pre-training Transformer (ChatGPT) also stated that all nursing di­
Thus, in this study, we aim to present opportunities of using Chat agnoses should be taken into account to formulate a nursing care plan

2
L. Gosak et al. Nurse Education in Practice 75 (2024) 103888

Fig. 1. Maria José Case Study.

Fig. 2. Nursing diagnosis using generative artificial intelligence tools.

based on the situation. To check compliance, we wanted to know from diagnosis. It is more appropriate to use the diagnosis "Risk for Impaired
which book the nursing diagnoses were provided. Appendix 1 demon­ Cardiovascular Function" (00132) instead". Based on that answer, we
strates part of the conversation where ChatGPT stated that the nursing stated to Generative Pre-training Transformer (ChatGPT): “The nursing
diagnoses are based on the North American Nursing Diagnosis Associ­ diagnosis "Risk for Impaired Respiratory Function" (00032) is also
ation – International (NANDA-I) 2021–2023 edition (Herdman, et al., inappropriate.” Generative Pre-training Transformer (ChatGPT),
2021). following our alert to the inappropriateness of the nursing diagnosis,
After a follow-up question (“Risk for Depression (NANDA-I code: provided an alternative possible nursing diagnosis: "It is more appro­
00198) - is this diagnosis part of NANDA-I?”) about whether Risk for priate to use the diagnosis "Impaired Gas Exchange" (00030) instead.".
Cardiovascular Disease (00146) is a diagnosis that is part of the North Based on the initial answer with the list of nursing diagnoses,
American Nursing Diagnosis Association – International (NANDA-I) Generative Pre-training Transformer (ChatGPT) also inappropriately
classification, ChatGPT replied: "I apologize for the confusion. "Risk for predicted two nursing diagnoses related to activity: Risk for Activity
Cardiovascular Disease" (00146) is not a valid NANDA-I nursing Intolerance (NANDA-I code: 00093), Risk for Impaired Physical Mobility

3
L. Gosak et al. Nurse Education in Practice 75 (2024) 103888

(NANDA-I code: 00085). Generative Pre-training Transformer The use of artificial intelligence will facilitate and improve human work
(ChatGPT) first highlighted the nursing diagnosis Risk of Depression and will not replace the work of healthcare professionals.Aartificial in­
(NANDA-I code: 00198) as part of the NANDA-I 2021–2023 classifica­ telligence is ready to support healthcare staff with a variety of tasks,
tion, but after pointing out that it was not found in the book, Generative from administrative workflow to clinical documentation (Bohr and
Pre-training Transformer (ChatGPT) added a clarification: "I apologize Memarzadeh, 2020). It has great potential in providing improvements in
for the confusion. After double-checking the NANDA-I 2021–2023 the safety of care (Bates, et al., 2021). The time spent by nurses on
publication, I must correct my previous response. "Risk for Depression" documentation can be very time consuming (De Groot, et al., 2022). De
(00198) is not included as an official nursing diagnosis in this edition. Groot, et al. (2022) estimated the time spent by charge nurses on
However, nurses may still use this phrase as a descriptive label to convey documentation to be an average of 8 hours per week. Aleandri, et al.
a patient’s risk of developing depression. It is important to note that it is (2022) found in their study that the average of correctly identified
not a standardized nursing diagnosis recognized by NANDA-I and nursing diagnoses according to the nursing assessment was 83.7%, while
therefore, care plans should focus on the actual nursing diagnoses the results suggest a shortcoming in the identification of interventions.
identified and their corresponding interventions." Different than Similarly, a similar exercise was carried out in a study by Falk and
NANDA-I, Generative Pre-training Transformer (ChatGPT) places more Björvell (2012) where 45 of 78 nursing diagnoses identical to those
emphasis on the symptoms described in the studies rather than on actual listed in the North American Nursing Diagnosis Association were
or potential health problems, which supports NANDA-I nursing di­ formulated in the two groups, 26 were very similar and close to the
agnoses as part of the classification. The only two nursing diagnoses North American Nursing Diagnosis Association diagnoses in content and
correctly listed by Generative Pre-training Transformer (ChatGPT) ac­ 7 were formulated as a symptom, 7 of these were formulated as a
cording to the NANDA-I 2021–2023 classification are Risk for Impaired symptom. Just as in practice not all nursing diagnoses are consistent
Skin Integrity (NANDA-I code: 00046) and Risk for Infection (NANDA-I with the taxonomy, or merely capture the patient’s problems in a
code: 00004). Only for the Risk for Infection diagnosis, Generative Pre- contextual way, Generative Pre-training Transformer (ChatGPT) pre­
training Transformer (ChatGPT) has provided the corresponding code dicts them in a similar way. Generative Pre-training Transformer
for the nursing diagnosis. (ChatGPT) makes it easier for nurses to manually classify nursing di­
Based on the initial diagnoses listed by Generative Pre-training agnoses and present them with the patient’s main problems. This saves
Transformer (ChatGPT), three nursing outcomes are highlighted for the nurse a significant amount of time on other work. It is important that
each nursing diagnosis (Appendix 2). The health professional is also nurses are aware of and educated in new innovations, can adapt to them
reminded that the outcomes need to be adapted to the given situation and provide quality care (Gunawan, 2023). Generative Pre-training
and the specific needs of the patient. Appendix 3 represents the in­ Transformer (ChatGPT) will become an integral part of the nursing ed­
terventions envisaged based on the Nursing Intervention Classification. ucation system due to its competence. Generative Pre-training Trans­
former (ChatGPT) will become an integral part of the nursing education
5. Discussion system due to its competence (Miao and Ahn, 2023).
Use of generative artificial intelligence in nursing is a fast-growing
Based on the results of this study, we conclude that Generative Pre- and changing field, with new solutions being developed daily. There­
training Transformer (ChatGPT) can be an important trainer and guide fore, it is difficult to assure the reproducibility of the results. Although in
for nurses in nursing process and patient care. Generative Pre-training this study, it was tried to set simple prompts for the Generative Pre-
Transformer (ChatGPT) adequately identifies Maria José’s diagnoses training Transformer (ChatGPT), the results obtained from updated
in terms of content but does not do so in accordance with the North version of Generative Pre-training Transformer (ChatGPT) might differ
American Nursing Diagnosis Association – International (NANDA-I) and will most likely provide an improved response.
classification. Artificial intelligence can play an important role in clin­
ical decision-making in healthcare (Norori, et al., 2021), which can have 6. Conclusions
a significant impact on the acquisition of important skills for nurses in
the areas of decision-making and critical thinking. Artificial intelligence It should be noted that some level of human fact-checking will al­
tools can facilitate and improve the knowledge acquisition of health ways be needed when using generative artificial intelligence methods.
professionals, but they cannot replace the decision-making of health How to implement this step and include a human-in-the-loop approach
professionals. Artificial intelligence can support healthcare pro­ to optimize the potential time saved using generative artificial intelli­
fessionals in tasks ranging from administrative workflow to tasks related gence represents one of the most important challenges in the future of
to clinical documentation (Bohr and Memarzadeh, 2020). In this study, modern data-driven nursing care.
we observe that there is a deviation from the answers reported by
Generative Pre-training Transformer (ChatGPT), as they include inap­ CRediT authorship contribution statement
propriate nursing diagnoses that are not part of NANDA-I. Generative
Pre-training Transformer (ChatGPT) gives wrong answers in some cases Pruinelli Lisiane: Conceptualization, Data curation, Formal anal­
because it was not built specifically to do nursing documentation and ysis, Methodology, Writing – review & editing. Gosak Lucija: Concep­
can prone to memory errors (Kleesiek, et al., 2023). tualization, Data curation, Formal analysis, Methodology, Writing –
Generative Pre-training Transformer (ChatGPT) correctly identified original draft, Writing – review & editing. Štiglic Gregor: Conceptual­
the most important health condition presented by the study’s patient ization, Data curation, Formal analysis, Methodology, Writing – original
and predicted where areas the greatest care was needed. It can teach draft, Writing – review & editing. Topaz Maxim: Conceptualization,
nurses the importance of taking a medical history, identifying deviations Data curation, Formal analysis, Methodology, Writing – review &
in patients from normal, setting care goals and suggesting potential editing.
nursing interventions. Generative Pre-training Transformer (ChatGPT)
used the provided information to suggest care interventions to health Declaration of Competing Interest
professionals so that they can achieve the desired goals of care,
regardless of the patient’s needs. As such, there is a high potential for The authors declare that they have no known competing financial
using generative artificial intelligence systems to support healthcare interests or personal relationships that could have appeared to influence
professionals in documenting the process of care, specifically nurses. the work reported in this paper.

4
L. Gosak et al. Nurse Education in Practice 75 (2024) 103888

Annex 1: Conversation between healthcare provider and ChatGPT (NANDA-I Nursing Diagnoses)

Health professional: Maria José is a 62-year-old accountant <<use case study description>>… Could you please
provide nursing diagnoses following the NANDA-I classification based on the case of the patient Maria José.Chat GPT:
Sure! Here are the nursing diagnoses with their corresponding NANDA codes: Risk for Cardiovascular Disease (00146)
related to obesity, sedentary lifestyle and hypertension as evidenced by elevated blood pressure readings. Risk for
Impaired Respiratory Function (00032) related to obesity, as evidenced by shortness of breath with physical activity.
Ineffective Health Maintenance (00078) related to lack of knowledge regarding healthy lifestyle choices as evidenced by
continued sedentary behavior and excessive body weight. Risk for Activity Intolerance (00093) related to obesity and
sedentary lifestyle as evidenced by shortness of breath with physical activity. Risk for Impaired Skin Integrity (00046)
related to obesity as evidenced by excessive skin folds and increased risk of skin breakdown. Risk for Infection (00004)
related to obesity and potential skin breakdown as evidenced by increased risk of skin infections. Risk for Impaired
Physical Mobility (00085) related to obesity and sedentary lifestyle as evidenced by limited physical activity and
shortness of breath with physical activity. Risk for Depression (00198) related to fear of retirement and unknown future
as evidenced by concern for depression in retired friends.
Chat GPT: Based on the information provided, the following nursing diagnoses can be made for Maria José using the
NANDA-I classification: Risk for Cardiovascular Disease related to obesity, sedentary lifestyle and hypertension as
evidenced by elevated blood pressure readings. Risk for Impaired Respiratory Function related to obesity, as evidenced
by shortness of breath with physical activity. Ineffective Health Maintenance related to lack of knowledge regarding
healthy lifestyle choices as evidenced by continued sedentary behavior and excessive body weight. Risk for Activity
Intolerance related to obesity and sedentary lifestyle as evidenced by shortness of breath with physical activity. Risk for
Impaired Skin Integrity related to obesity as evidenced by excessive skin folds and increased risk of skin breakdown.
Risk for Infection related to obesity and potential skin breakdown as evidenced by increased risk of skin infections. Risk
for Impaired Physical Mobility related to obesity and sedentary lifestyle as evidenced by limited physical activity and
shortness of breath with physical activity. Risk for Depression related to fear of retirement and unknown future as
evidenced by concern for depression in retired friends. It is important for Maria José to work with her healthcare team to
develop a plan for lifestyle changes to address these nursing diagnoses and reduce her risk for chronic diseases.
Health professional: Could you please add the NANDA codes?
Chat GPT: Sure! Here are the nursing diagnoses with their corresponding NANDA codes: Risk for Cardiovascular Disease
(00146) related to obesity, sedentary lifestyle and hypertension as evidenced by elevated blood pressure readings. Risk
for Impaired Respiratory Function (00032) related to obesity, as evidenced by shortness of breath with physical activity.
Ineffective Health Maintenance (00078) related to lack of knowledge regarding healthy lifestyle choices as evidenced by
continued sedentary behavior and excessive body weight. Risk for Activity Intolerance (00093) related to obesity and
sedentary lifestyle as evidenced by shortness of breath with physical activity. Risk for Impaired Skin Integrity (00046)
related to obesity as evidenced by excessive skin folds and increased risk of skin breakdown. Risk for Infection (00004)
related to obesity and potential skin breakdown as evidenced by increased risk of skin infections. Risk for Impaired
Physical Mobility (00085) related to obesity and sedentary lifestyle as evidenced by limited physical activity and
shortness of breath with physical activity. Risk for Depression (00198) related to fear of retirement and unknown future
as evidenced by concern for depression in retired friends.

Annex 2: Conversation between healthcare provider and ChatGPT (Nursing Outcomes Classification NOC)

Health professional: Could you please suggest the nursing outcomes based on the NOC classification for Maria’s
diagnoses?
Chat GPT: Sure, here are some nursing outcomes for Maria José’s nursing diagnoses using the Nursing Outcomes
Classification (NOC): Risk for Cardiovascular Disease: Blood Pressure Control (1401) Cardiovascular Status (1404)
Health-Promoting Behaviors (1202) Risk for Impaired Respiratory Function: Respiratory Status: Airway Patency (0424)
Respiratory Status: Gas Exchange (0420) Activity Tolerance (0005) Ineffective Health Maintenance: Health-Promoting
Behaviors (1202) Knowledge: Health Behavior (1802) Self-Care: Activities of Daily Living (1101) Risk for Activity
Intolerance: Activity Tolerance (0005) Cardiopulmonary Status: Oxygen Saturation (0417) Mobility Level (0201) Risk
for Impaired Skin Integrity: Skin Condition (1106) Skin Integrity (1104) Skin Surveillance (1107) Risk for Infection:
Infection Control (0507) Knowledge: Infection Control (1801) Wound Healing (1103) Risk for Impaired Physical
Mobility: Mobility Level (0201) Muscle Function (0305) Range-of-Motion (0203) Risk for Depression: Coping (1305)
Emotional Status (1205) Social Support (1308) It is important to note that the selection of specific NOC outcomes should
be based on the individual needs and goals of the patient, as well as the expertize of the nursing staff.

Annex 3: Conversation between healthcare provider and ChatGPT (Nursing Intervention Classifications NIC)

Health professional: Could you please suggest the nursing interventions based on the NIC classification for the nursing
diagnoses identified for Maria?
Chat GPT: Sure, here are some nursing interventions for Maria José’s nursing diagnoses using the Nursing Interventions
Classification (NIC): Risk for Cardiovascular Disease: Blood Pressure Management (3320) Exercise Therapy (1400)
Health Education (5460) Risk for Impaired Respiratory Function: Airway Management (3150) Oxygen Therapy (3152)
Activity Therapy (0400) Ineffective Health Maintenance: Health Education (5460) Nutrition Management (1100) Self-
care Assistance (1800) Risk for Activity Intolerance: Energy Management (1875) Exercise Therapy (1400) Restorative
Care (1870) Risk for Impaired Skin Integrity: Skin Care (1290) Wound Care (3590) Pressure Ulcer Prevention (3380)
Risk for Infection: Infection Control (6540) Health Education (5460) Wound Care (3590) Risk for Impaired Physical
Mobility: Exercise Therapy (1400) Mobility Assistance (1805) Positioning (2320) Risk for Depression: Counseling
(5220) Emotional Support (5240) Referral (5600) It is important to note that the selection of specific NIC interventions
should be based on the individual needs and goals of the patient, as well as the expertize of the nursing staff.

5
L. Gosak et al. Nurse Education in Practice 75 (2024) 103888

References artificial intelligence in healthcare: a skin cancer application. Sensors 22 (16), 6145.
https://doi.org/10.3390/s22166145.
Lee, B., 2007. Identifying outcomes from the nursing outcomes classification as
Aleandri, M., Scalorbi, S., Pirazzini, M.C., 2022. Electronic nursing care plans through
indicators of quality of care in Korea: a modified delphi study. Int. J. Nurs. Stud. 44
the use of NANDA, NOC and NIC taxonomies in community setting: a descriptive
(6), 1021–1028. https://doi.org/10.1016/j.ijnurstu.2006.03.016.
study in northern Italy. Int. J. Nurs. Knowl. 33 (1), 72–80. https://doi.org/10.1111/
Lubowitz, J.H., 2023. ChatGPT, an artificial intelligence chatbot, is impacting medical
2047-3095.12326.
literature. Arthroscopy 39 (5), 1121–1122. https://doi.org/10.1016/j.
Asmirajanti, M., Hamid, A.Y.S., Hariyati, R.T.S., 2019. Nursing care activities based on
arthro.2023.01.015.
documentation. BMC Nurs. 18 (1), 1–5. https://doi.org/10.1186/s12912-019-0352-
Maas, M.L., Reed, D., Reeder, K.M., Kerr, P., Specht, J., Johnson, M., Moorhead, S., 2002.
0.
Nursing outcomes classification: a preliminary report of field testing. Outcomes
Basu, K., Sinha, R., Ong, A., Basu, T., 2020. Artificial intelligence: how is it changing
Manag. 6 (3), 112–119.
medical sciences and its future? Indian J. Dermatol. 65 (5), 365. https://doi.org/
Malik, P., Pathania, M., Rathaur, V.K., 2019. Overview of artificial intelligence in
10.4103/ijd.IJD_421_20.
medicine. J. Fam. Med. Prim. Care 8 (7), 2328. https://doi.org/10.4103/jfmpc.
Bates, D.W., Levine, D., Syrowatka, A., Kuznetsova, M., Craig, K.J.T., Rui, A., Jackson, G.
jfmpc_440_19.
P., Rhee, K., 2021. The potential of artificial intelligence to improve patient safety: a
Miao, H., Ahn, H., 2023. Impact of ChatGPT on interdisciplinary nursing education and
scoping review. NPJ Digit. Med. 4 (1), 54 https://doi.org/10.1038/s41746-021-
research. Asian/Pac. Isl. Nurs. J. 7 (1), e48136 https://doi.org/10.2196/48136.
00423-6.
Norori, N., Hu, Q., Aellen, F.M., Faraci, F.D., Tzovara, A., 2021. Addressing bias in big
Bohr, A., Memarzadeh, K., 2020. The rise of artificial intelligence in healthcare
data and AI for health care: a call for open science. Patterns 2 (10). https://doi.org/
applications. Artificial Intelligence in Healthcare. Academic Press,, pp. 25–60.
10.1016/j.patter.2021.100347.
https://doi.org/10.1016/B978-0-12-818438-7.00002-2.
Park, J., Jeong, S., 2022. The analysis of nursing diagnoses determined by students for
Bulechek, G.M., Butcher, H.K., Dochterman, J.M.M., Wagner, C., 2012. Nursing
patients in rehabilitation units. J. Exerc. Rehabil. 18 (5), 299. https://doi.org/
interventions classification (NIC). Elsevier Health Sci. ISBN: 9780323497688.
10.12965/jer.2244336.168.
Carayon, P., Gurses, A. P., 2008. Nursing workload and patient safety—a human factors
Patel, S.B., Lam, K., 2023. ChatGPT: the future of discharge summaries? Lancet Digit.
engineering perspective. Patient safety and quality: An evidence-based handbook for
Health 5 (3), e107–e108. https://doi.org/10.1016/S2589-7500(23)00021-3.
nurses.
Roumeliotis, N., Parisien, G., Charette, S., Arpin, E., Brunet, F., Jouvet, P., 2018.
Castonguay, A., Farthing, P., Davies, S., Vogelsang, L., Kleib, M., Risling, T., Green, N.,
Reorganizing care with the implementation of electronic medical records: a time-
2023. Revolutionizing nursing education through Ai integration: a reflection on the
motion study in the PICU. Pediatr. Crit. Care Med. 19 (4), e172–e179. https://doi.
disruptive impact of ChatGPT. Nurse Educ. Today 129, 105916. https://doi.org/
org/10.1097/PCC.0000000000001450.
10.1016/j.nedt.2023.105916.
Scerri, A., Morin, K.H., 2023. Using chatbots like ChatGPT to support nursing practice.
Daly, J.M., Maas, M.L., Johnson, M., 1997. Nursing outcomes classification. An essential
J. Clin. Nurs. https://doi.org/10.1111/jocn.16677.
element in data sets for nursing and health care effectiveness. Suppl Comput. Nurs.
Schenk, E., Schleyer, R., Jones, C.R., Fincham, S., Daratha, K.B., Monsen, K.A., 2017.
15 (2). S82-6. PMID: 9099041.
Time motion analysis of nursing work in ICU, telemetry and medical-surgical units.
De Cordova, P.B., Lucero, R.J., Hyun, S., Quinlan, P., Price, K., Stone, P.W., 2010. Using
J. Nurs. Manag. 25 (8), 640–646. https://doi.org/10.1111/jonm.12502.
the nursing interventions classification as a potential measure of nurse workload.
Seçer, S., Karaca, A., 2021. Evaluation of nurses’ perceptions of nursing diagnoses and
J. Nurs. Care Qual. 25 (1), 39. https://doi.org/10.1097/NCQ.0b013e3181b3e69d.
their opinions regarding the application of nursing process. Florence Nightingale J.
De Groot, K., De Veer, A.J., Munster, A.M., Francke, A.L., Paans, W., 2022. Nursing
Nurs. 29 (2), 229. https://doi.org/10.5152/FNJN.2021.20034.
documentation and its relationship with perceived nursing workload: a mixed-
Seibert, K., Domhoff, D., Bruch, D., Schulte-Althoff, M., Fürstenau, D., Biessmann, F.,
methods study among community nurses. BMC Nurs. 21 (1), 1–12. https://doi.org/
Wolf-Ostermann, K., 2021. Application scenarios for artificial intelligence in nursing
10.1186/s12912-022-00811-7.
care: rapid review. J. Med. Internet Res. 23 (11), e26522 https://doi.org/10.2196/
Falk, J., Björvell, C., 2012. Does the use of a classification for nursing diagnoses affect
26522.
nursing students’ choice of nursing interventions? In: Proceedings of the NI 2012:
Shin, J.H., Choi, G.Y., Lee, J., 2021. Identifying frequently used NANDA-I nursing
11th International Congress on Nursing Informatics, June 23-27, 2012, Montreal,
diagnoses, NOC outcomes, NIC interventions and NNN linkages for nursing home
Canada. (Vol. 2012). American Medical Informatics Association. PMID: 24199065.
residents in Korea. Int. J. Environ. Res. Public Health 18 (21), 11505. https://doi.
Floridi, L., Chiriatti, M., 2020. GPT-3: Its nature, scope, limits and consequences. Minds
org/10.3390/ijerph182111505.
Mach. 30, 681–694. https://doi.org/10.1007/s11023-020-09548-1.
Taghavi Larijani, T., Saatchi, B., 2019. Training of NANDA-I nursing diagnoses (NDs),
Gunawan, J., 2023. Exploring the future of nursing: insights from the ChatGPT model.
nursing interventions classification (NIC) and nursing outcomes classification (NOC),
Belitung Nurs. J. 9 (1), 1–5. https://doi.org/10.33546/bnj.2551.
in psychiatric wards: a randomized controlled trial. Nurs. Open 6 (2), 612–619.
Håkans, V.B., 2012. Nurses’ perception of nursing diagnosis. In: Proceedings of the NI
https://doi.org/10.1002/nop2.244.
2012: 11th International Congress on Nursing Informatics, June 23-27, 2012,
Tam, W., Huynh, T., Tang, A., Luong, S., Khatri, Y., Zhou, W., 2023. Nursing education in
Montreal, Canada. (Vol. 2012). American Medical Informatics Association. PMID:
the age of artificial intelligence powered Chatbots (AI-Chatbots): are we ready yet?
24199050.
Nurse Educ. Today 129, 105917. https://doi.org/10.1016/j.nedt.2023.105917.
Hendrich, A., Chow, M.P., Skierczynski, B.A., Lu, Z., 2008. A 36-hospital time and
Toney-Butler, T.J., Thayer, J.M., 2022. Nursing process. In StatPearls [Internet].
motion study: how do medical-surgical nurses spend their time? Perm. J. 12 (3), 25.
StatPearls Publ.
https://doi.org/10.7812/tpp/08-021.
Westbrook, J.I., Duffield, C., Li, L., Creswick, N.J., 2011. How much time do nurses have
Herdman, T.H., Kamitsuru, S., Lopes K. (eds.), 2021. NANDA-I 2021-2023.
for patients? A longitudinal study quantifying hospital nurses’ patterns of task time
Irving, G., Neves, A.L., Dambha-Miller, H., Oishi, A., Tagashira, H., Verho, A., Holden, J.,
distribution and interactions with health professionals. BMC Health Serv. Res. 11,
2017. International variations in primary care physician consultation time: a
1–12. https://doi.org/10.1186/1472-6963-11-319.
systematic review of 67 countries. BMJ Open 7 (10), e017902. https://doi.org/
Yen, P.Y., Kellye, M., Lopetegui, M., Saha, A., Loversidge, J., Chipps, E.M., Gallagher-
10.1136/bmjopen-2017-017902.
Ford, L. and Buck, J., 2018. Nurses’ time allocation and multitasking of nursing
Jo, A., 2023. The promise and peril of generative AI. Nature 614 (1), 214–216.
activities: a time motion study. In AMIA annual symposium proceedings (Vol. 2018,
Kleesiek, J., Wu, Y., Stiglic, G., Egger, J., Bian, J., 2023. An opinion on ChatGPT in health
p. 1137). American Medical Informatics Association. PMID: 30815156.
care—written by humans only. J. Nucl. Med. 64 (5), 701–703. https://doi.org/
Zamanzadeh, V., Valizadeh, L., Tabrizi, F.J., Behshid, M., Lotfi, M., 2015. Challenges
10.2967/jnumed.123.265687.
associated with the implementation of the nursing process: a systematic review. Iran.
La Salvia, M., Torti, E., Leon, R., Fabelo, H., Ortega, S., Martinez-Vega, B., Callico, G.M.,
J. Nurs. Midwifery Res. 20 (4), 411. https://doi.org/10.4103/1735-9066.161002.
Leporati, F., 2022. Deep convolutional generative adversarial networks to enhance