The Role of Digital Literacy and Ethical Awareness in Nurses’ Artificial Intelligence Acceptance: A Cross-sectional Questionnaire Survey

Abstract

Background The integration of artificial intelligence into healthcare is rapidly transforming clinical practice. Nurses’ acceptance of artificial intelligence is influenced by their digital literacy and ethical awareness, yet empirical evidence examining these interrelationships is limited. Objective We aimed to examine the direct and indirect effects of digital literacy on nurses’ acceptance of artificial intelligence, with ethical awareness of artificial intelligence serving as a mediating factor. Methods A cross-sectional, correlational design was conducted among 350 nurses working in medical-surgical and critical care units at El-Kasr Al-Aini hospital in Egypt from March 2025 to December 2025. Participants completed validated instruments assessing digital literacy, artificial intelligence ethical awareness, and artificial intelligence acceptance. Data were analyzed using descriptive statistics, Pearson correlations, and structural equation modeling (SEM) with bootstrapping to assess mediation effects. Results Participants demonstrated moderate levels of digital literacy, artificial intelligence ethical awareness, and artificial intelligence acceptance. SEM analysis revealed that digital literacy had a significant direct effect on artificial intelligence acceptance (β = 0.29, p < 0.001) and a strong effect on artificial intelligence ethical awareness (β = 0.46, p < 0.001). Artificial intelligence ethical awareness significantly mediated the relationship between digital literacy and artificial intelligence acceptance (indirect effect β = 0.13, p < 0.001), indicating partial mediation. The model exhibited good fit indices: chi-square/df (χ²/df) = 1.98, Comparative Fit Index= 0.95, Tucker–Lewis Index= 0.93, Root Mean Square Error of Approximation= 0.057, and Standardized Root Mean Square Residual= 0.045. Conclusion Digital literacy enhanced participants' acceptance of artificial intelligence both directly and indirectly through ethical awareness. Ethical preparedness may, therefore, be a critical factor alongside technical competence in promoting artificial intelligence adoption among Egyptian nurses. Relevance to clinical practice Integrating digital literacy training with ethical education in Egyptian nursing curricula and continuing professional development programs may be able to facilitate safe and effective artificial intelligence adoption, supporting high-quality patient care in technologically advanced healthcare environments.