ChatGPT use linked to self-reported reasoning among Ugandan nursing students

Ugandan undergraduate nursing students who used ChatGPT for academic or clinical learning reported using it frequently across eight nursing-related activities, and their reported use was moderately associated with stronger self-reported clinical reasoning. A cross-sectional survey of 420 students at 13 universities found a Pearson correlation of r = 0.661 between ChatGPT use and self-reported clinical reasoning, with a 95% confidence interval of 0.603–0.712 and p < 0.001. The result shows an association between reported behavior and students’ perceptions, not proof that ChatGPT improved their reasoning.

The study was conducted from 2 to 27 February 2026 at 13 Ugandan universities, comprising six public and seven private institutions. Participants were undergraduate nursing students who had previously used ChatGPT for nursing-related academic or clinical learning. Sampling was organized by year of study within each participating institution.

Of the 480 students invited, 420 submitted questionnaires that met the prespecified completeness criterion, giving a response rate of 87.5% and a final analytical sample of 420. A 41-item structured questionnaire assessed eight types of ChatGPT use, perceived usefulness, self-reported clinical reasoning, challenges and responsible-use practices. Researchers analysed the responses using descriptive statistics, Pearson correlation, group comparisons and exploratory multiple linear regression.

The analysis was conducted in IBM SPSS Statistics version 31.0. Students reported using ChatGPT to understand disease processes, clarify nursing concepts, prepare for examinations, develop care plans, learn clinical procedures, analyse patient cases, obtain medication information and compare nursing interventions. Reported use across these activities had a grand mean of 4.12 and a standard deviation of 0.81.

Perceived usefulness was also rated highly, with a grand mean of 4.28 and a standard deviation of 0.73. Self-reported clinical reasoning averaged 4.17, with a standard deviation of 0.76. An exploratory multiple linear regression model was statistically significant, with F(7, 412) = 78.34, p < 0.001 and an adjusted R² of 0.563.

The variance inflation factors ranged from 1.08 to 1.98, which did not indicate multicollinearity in the model. A null random-intercept analysis found minimal clustering by university, with an intraclass correlation coefficient of 0.008 and a 95% confidence interval of 0.000–0.071. The authors interpreted the findings as indicating that the association between ChatGPT use and self-reported reasoning was particularly evident in the context of high perceived usefulness and reported verification practices.

The survey provides evidence that generative artificial intelligence was already part of nursing education for the students who participated, rather than an isolated or occasional tool. It also documents the range of tasks for which respondents used ChatGPT, from clarifying concepts and reviewing clinical procedures to analysing patient cases and comparing nursing interventions. The strongest defensible conclusion is that more intensive reported ChatGPT use was associated with higher self-reported clinical reasoning, while perceived usefulness was independently measured as a student perception rather than as a demonstrated cause of that relationship.

Several limitations prevent a causal interpretation. The cross-sectional design captured associations at one point in time and could not determine whether students used ChatGPT more because they already felt confident in their reasoning or whether use contributed to that confidence. The authors called for future research using validated measurement models and objective, performance-based outcomes.

They also recommended longitudinal or experimental designs to examine whether ChatGPT use precedes changes in reasoning, along with multilevel or cluster-robust analyses when institutional dependence is relevant.

Subject of Research: Associations among ChatGPT use, perceived usefulness and self-reported clinical reasoning among undergraduate nursing students in Uganda

Article Title: ChatGPT use, perceived usefulness, and self-reported clinical reasoning among undergraduate nursing students in Uganda: a cross-sectional study

Article References: Afam, G., & Uzorka, A. (2026). ChatGPT use, perceived usefulness, and self-reported clinical reasoning among undergraduate nursing students in Uganda: a cross-sectional study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10388-3

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10388-3

Keywords: ChatGPT, generative AI, nursing education, clinical reasoning, Uganda, undergraduate nursing students, cross-sectional study, self-reported measures, educational technology, perceived, usefulness, self-reported