Association between artificial intelligence literacy and empathic behavior among nursing interns: adjustment for moral distress and moral resilience

Background Artificial intelligence (AI) literacy is increasingly relevant in nursing education, yet its association with empathic behavior among nursing interns remains unclear. Methods This cross-sectional study included 300 nursing interns from three tertiary hospitals in China (December 2025–April 2026). AI literacy and empathic behavior were assessed using validated scales. Moral distress and moral resilience were included as covariates. Multivariable linear regression and restricted cubic spline analyses were performed, with subgroup analyses to assess robustness. Results Higher AI literacy was significantly associated with greater empathic behavior in the unadjusted model ( β = 4.40; 95% CI, 3.86–4.95; P < .001) and fully adjusted model ( β = 4.31; 95% CI, 3.40–5.23; P < .001). No evidence of a nonlinear association was observed (P for nonlinearity = .886), and the association was broadly consistent across prespecified subgroups. Conclusions Higher AI literacy was statistically associated with greater empathic behavior among nursing interns. Longitudinal and intervention studies are needed to determine the temporal and causal relationships between these constructs.