A world defined by technology has arrived. In line with these changes, artificial intelligence (AI) has emerged as a primary area of interest and discussion [1]. It has actively permeated every aspect of our lives, making the coexistence of humans and AI indispensable [2,3]. Among the various forms of AI, chatbots represent one of the most commonly encountered AI-based tools in our daily lives.

Chatbots are characterized by their ability to communicate with users and machines via text or voice. If a user has a question or is simply curious, chatbots can interact with them, providing appropriate answers or information as though they were human [4,5]. These characteristics allow chatbots to be seamlessly integrated into educational or learning environments, facilitating smooth interactions between teachers and students, or among students themselves [6]. Furthermore, the user-friendly interface of chatbots has been recognized for its potential [7]. Consequently, researchers have been motivated to develop a variety of chatbots for educational use among elementary and middle school students [3-7].

Before the COVID-19 outbreak, traditional classroom-based, face-to-face instruction was the mainstay of nursing education [8]. However, the global spread of COVID-19 necessitated changes in educational modalities, leading to a heightened interest in alternatives to traditional classes [3]. Concurrently, efforts have been made to adapt education to align with shifts in the educational paradigm. As such, there has been a growing demand for changes that facilitate knowledge delivery in a teacher-centered educational environment.

The current generation of nursing students, having been raised in an era of social networking, online videos, and emails, is highly familiar with internet technology. As such, it is anticipated that their learning preferences may differ from previous generations. The incorporation of these technologies into their educational curriculum appears to yield positive outcomes.

While the use of chatbots has traditionally been confined to service areas, there has been a growing trend towards their wider application in education [5,8,9]. However, the effectiveness of this technology in nursing education is still a subject of debate. Before we can determine the efficacy of chatbots in nursing, it is crucial to build awareness among potential users. Despite this, there is a dearth of studies exploring the awareness of chatbots among undergraduate nursing students in Korea. Chang et al. [2] have noted that research on the use of chatbots in nursing education is scarce. Therefore, this study investigated nursing students' awareness of the use of chatbots (AuC) prior to their implementation in nursing education.

The extended technology acceptance model (ETAM) [10] was utilized as a conceptual framework for this study. This model is derived from Davis' [11] technology acceptance model (TAM), which investigates the motivations and attitudes of users when new technology is introduced. The ETAM incorporates external variables that influence the adoption or acceptance of novel technologies, and it is frequently employed in AI studies to ascertain consumer acceptance of new technology. In this study, following a previous study [12], perceived value was incorporated as a key external variable in the intention to use. Therefore, the conceptual framework of AuC in this study consisted of four dimensions: perceived value (comprising three components: professionalism, reliability, and empathy), perceived usefulness, perceived ease of use, and intention to use. These dimensions shape the acceptance of new technologies (Figure 1).

This study investigated nursing students' AuC related to nursing education. The specific purposes were to identify (a) the degree of AuC across its four dimensions (perceived value, perceived usefulness, perceived ease of use, and intention to use); (b) differences in AuC according to the participants' characteristics; (c) correlations among the four dimensions of AuC; and (d) factors influencing participants' intention to use chatbots.

AI technology has become part of the reality of today's teaching and learning and has noticeably improved higher education, including nursing education [15]. In this section, we discuss the results of this study and the four dimensions with regard to the conceptual framework used in the ETAM.

The mean AuC score was 3.49±0.61, indicating a generally positive perception of using chatbots in nursing education. However, this result was lower than anticipated, potentially due to a significant number of participants lacking prior experience with chatbot usage. In a survey of college students [16], most (79%) students exhibited positive attitudes toward the use of educational chatbots that make them more effective as learners. A study focusing on elementary school students reported an AuC score of 3.43±0.83 [17]. In a separate study by Mo [18], which explored undergraduate and graduate students' awareness of digital storytelling chatbots, the average awareness score, based on a 5-point Likert scale, was 4.22. Despite the different target groups, it seems that undergraduate students view the use of chatbots favorably.

Among the three components of perceived value (professionalism, reliability, and empathy), professionalism scored above the midpoint. This aligns with the findings of Chu et al. [12], who reported a direct correlation between professionalism and user satisfaction. This suggests that implementing chatbots in education could enhance participant satisfaction. This notion is further supported by Tatnall [19], who posits that chatbots hold significant educational potential due to their ability to provide timely and relevant information through direct interactions. The reliability score, which was above the median level, suggests that students perceive chatbot technology as a dependable educational tool. This is consistent with the findings of Yin et al. [20], who reported that chatbots are a promising learning technology. Studies related to the TAM have also shown that user reliability is a crucial factor in sustaining long-term relationships between users and providers [9,12]. Empathy was the component of perceived value with the lowest score. A chatbot is a communication application that simulates human conversation through text [20], and its use can potentially enhance learners' communication skills [8]. Furthermore, chatbots, much like humans, can make learners feel as though they are interacting with another person [2,4,9], thereby boosting their motivation to learn and their immersion in the learning process.

The perceived usefulness score among participants in this study was notably above midpoint, aligning with the findings of other research [17]. Studies conducted on elementary school students in Taiwan and Korea have demonstrated that chatbots can effectively stimulate students' interest and confidence [4,21,22]. Chang et al. [8] suggested that chatbot technology can enhance the efficiency of nursing education by addressing issues through the chatbot system. They also evaluated academic performance metrics such as learning efficiency and effectiveness, revealing that students who utilized the chatbot system outperformed those who depended on traditional teaching methods. This can be attributed to chatbots serving as assistants or learning facilitators, providing immediate feedback tailored to students' needs. This enables prompt corrections and imparts accurate knowledge based on the feedback received [23]. Education facilitated by chatbots reinforces perceived value and the usefulness of active, self-directed learning [20].

In this study, the perceived ease of use demonstrated a score that was above midpoint, mirroring the findings of a previous study [17]. The use of chatbots facilitates easy access to learning content via the internet and mobile devices [23,24]. This suggests that for the current generation, chatbots are akin to other social chat tools with which they are already familiar [20]. As a result, nursing students can readily access these chatbots.

Intention to use refers to an individual's willingness to utilize a particular technology or service [25]. In this context, it pertains to students' attitudes towards and readiness to incorporate chatbot technology into their education. Davis [11] emphasized that intention to use is a significant factor in determining an individual's motivation to routinely use a technology or endorse it to others. When users develop a sense of trust, their intention to use a chatbot tends to increase. In this study, the average score for intention to use was 3.36±0.87.

Significant differences were observed in the participants' AuC scores in relation to their satisfaction with nursing, the effectiveness of various nursing education methods, and interest in chatbots. These results could suggest a heightened academic interest and motivation, particularly in educational methods, and an increased awareness of new educational approaches, including chatbots. Han et al. [23] have suggested that an increased interest in using chatbot programs could indicate their potential as a valuable educational tool for nursing students. Similarly, Buchanan et al. [24] have highlighted the importance of educational programs that utilize AI, as they can provide safe and efficient learning opportunities for nursing students.

The correlations among the four dimensions were both significant and positive, a finding that aligns with a previous study targeting elementary school students [17]. A separate study, utilizing the ETAM, explored consumers' intentions to use the metaverse. It reported that participants' perceived usefulness and ease of use were significantly and positively related [26]. This finding was echoed in another study that employed the TAM to analyze factors influencing consumers' intention to use, confirming a significant positive relationship between perceived usefulness, ease of use, and intention to use [9]. These results underscore the importance of enhancing the perceived value, usefulness, and ease of use of chatbots to increase their intended use. These factors should be taken into account during the design and development of chatbots to ensure their efficient application in nursing education.

In the final regression analysis, interest in chatbots and perceived value were identified as factors influencing nursing students' intention to use chatbots. The same result regarding interest in chatbots was reported by Min et al. [9] and Chu et al. [12]. An explanation for this may be that using chatbots is a pleasant experience and creates a sense of immersion rather than boredom. In addition, those studies reported that perceived usefulness and perceived ease to use influenced students' intention to use. If a chatbot is thought to have a learning effect and is convenient to use, the intention to use is likely to increase. The components of perceived value, which include professionalism, reliability, and empathy, can be defined as the subjective evaluations that individuals make when selecting services [27]. The findings of this study align with those of previous studies, which suggest that perceived value can influence the intention to use AI technologies such as chatbots [12,26,28]. Therefore, it could be suggested that perceived value should be strategically considered when developing chatbots for nursing students to enhance their intention to use such technology.

The application of AI technology, including tools like chatbots, can enhance learning effectiveness and engagement across various disciplines, including nursing. It is anticipated that AI will revolutionize education, and the influence of technological progress on nursing education is undeniable. Numerous studies underscore the advantages of incorporating technology into nursing education [15]. In the wake of the COVID-19 pandemic and the ensuing social distancing measures, technology has become the cornerstone of teaching and learning. There is widespread speculation that future threats akin to COVID-19 will necessitate a shift in educational modalities [29]. There is increasing evidence to suggest that chatbots can revolutionize the learning process for students by providing interactive educational support [30]. The incorporation of technology into nursing education promotes selfguided and continuous learning, thereby enabling educators to enhance the quality of their instruction [8]. Furthermore, it supports personalized learning by offering accessibility, scalability, and affordability [15,24,30].

As nursing education shifts away from traditional teaching methods [24,29], it is crucial for nursing educators in institutions to prepare for the future integration of AI. Undergraduate nursing curricula may need to be updated to include AI competencies, thereby promoting the use of AI technology. To keep pace with current trends and guide a new generation of nursing students, nursing educators must actively engage with this rapidly evolving advancement. Furthermore, nursing educators can serve as designers, creating a learning environment that fosters technologically proficient professionals and enhances its effectiveness [24].

Although this rapidly expanding teaching and learning method does present some challenges, this study carries significant implications for nursing education. It reveals a positive perception of chatbots among students, indicating a need to modify educational approaches and incorporate AI chatbots as an effective learning tool. The primary value of this study lies in its provision of supportive data regarding the potential application of chatbots in nursing education. Future research should focus on assessing the educational impact on learning outcomes and student satisfaction in nursing when interacting with chatbots.

It should be noted that this study has some limitations. First, the participants were selected from a single city using convenience sampling, which may not provide a representative sample of all nursing school students. Future research should aim to include larger sample sizes from a variety of regions. Second, our methodology relied on a self-reported questionnaire. To gain a more comprehensive understanding of nursing students' awareness, a more in-depth investigation is recommended. Third, our study focused solely on junior and senior nursing students. To corroborate these findings, it would be beneficial to include teachers in future studies. This would help address any potential discrepancies between the two groups, which would need to be interpreted from a unique perspective. Finally, despite testing for reliability and validity, the tool we used was modified to suit this study. Consequently, additional research is required to confirm the validity of this scale.

Chatbots are increasingly being utilized in the field of education. Despite a few challenges and disadvantages linked to this technology, its usage continues to expand. This study investigated AuC among nursing students, demonstrating that technologies like chatbots can be employed to enhance learning. This implies the potential of using chatbots as an educational tool for nursing students. In addition, factors influencing the intention to use chatbots were identified. Hence, there is a need to develop learning strategies that can provide educational benefits by using chatbots in nursing education.