{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T09:07:12Z","timestamp":1790672832498,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","award":["2025JJ60785"],"award-info":[{"award-number":["2025JJ60785"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002767","name":"Department of Science and Technology of Hunan Province","doi-asserted-by":"publisher","award":["2024JJ9226"],"award-info":[{"award-number":["2024JJ9226"]}],"id":[{"id":"10.13039\/501100002767","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing Open"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The association between artificial intelligence simulation\u2010system usability and nursing students' learning engagement remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim(s)<\/jats:title>\n                    <jats:p>To examine cross\u2010sectional indirect associations linking system usability, extraneous cognitive load, flow, and learning engagement, and explore moderation by digital readiness among nursing students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>The hospital research team conducted an online cross\u2010sectional survey of 2016 nursing students. Teachers at 16 colleges provided only voluntary, public\u2010interest assistance by forwarding the survey link; neither the colleges nor their personnel were participating research institutions. Established measures, structural equation modelling, bootstrap tests, and multi\u2010group analysis were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Higher usability was associated with lower extraneous load and higher engagement; lower load with greater flow, and greater flow with engagement. The sequential indirect association was supported. The load\u2010flow association was stronger at lower digital readiness. Concurrent measurement precludes causal inference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Usability, extraneous cognitive load, flow, and engagement showed theoretically ordered cross\u2010sectional associations. Longitudinal or experimental studies are needed to test temporal ordering.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review Methods<\/jats:title>\n                    <jats:p>Not applicable to this empirical cross\u2010sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>From August to December 2025, the hospital research team conducted an online anonymous survey of 2016 nursing students. Teachers at 16 colleges only assisted in forwarding the questionnaire link and were not participating research institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for the Profession and\/or Patient Care<\/jats:title>\n                    <jats:p>Accessible interfaces and differentiated support should be considered, especially for less digitally ready students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>The study addressed the gap in understanding the psychological pathways (cognitive load and flow) that link the usability of AI systems to nursing students' engagement in virtual simulation. Higher usability was associated with lower load, greater flow, and higher engagement; the load\u2010flow association varied by digital readiness. The findings may inform accessible simulation\u2010system design for diverse nursing students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>The Strengthening the Reporting of Observational Studies in Epidemiology checklist was followed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>No Patient or Public Contribution<\/jats:title>\n                    <jats:p>No patient or members of the public were involved because participants were nursing students.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nop2.70855","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:15:53Z","timestamp":1789762553000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>AI<\/scp>\n                    System Usability and Learning Engagement in Nursing Simulation: Cross\u2010Sectional Statistical Indirect Associations Through Extraneous Cognitive Load and Flow Experience"],"prefix":"10.1002","volume":"13","author":[{"given":"Mengjiao","family":"Liu","sequence":"first","affiliation":[{"name":"Trauma Center The Second Xiangya Hospital, Central South University  Changsha Hunan China"},{"name":"Clinical Nursing Teaching and Research Section The Second Xiangya Hospital, Central South University  Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8703-340X","authenticated-orcid":false,"given":"Ping","family":"Zhang","sequence":"additional","affiliation":[{"name":"Clinical Nursing Teaching and Research Section The Second Xiangya Hospital, Central South University  Changsha Hunan China"},{"name":"Department of Neurosurgery The Second Xiangya Hospital, Central South University  Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeqing","family":"Wu","sequence":"additional","affiliation":[{"name":"Clinical Nursing Teaching and Research Section The Second Xiangya Hospital, Central South University  Changsha Hunan China"},{"name":"Department of Neurosurgery The Second Xiangya Hospital, Central South University  Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6262-4124","authenticated-orcid":false,"given":"Lu","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The Second Xiangya Hospital, Central South University  Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pathology The Second Xiangya Hospital, Central South University  Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"issue":"4","key":"e_1_2_14_2_1","first-page":"E113","article-title":"Assessing the Usability of E\u2010Learning Software Among University Learners: A Cross\u2010Sectional Study","volume":"48","author":"Alqurni J.","year":"2023","journal-title":"Nurse Educator"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-025-03199-2"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nepr.2025.104554"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/2688003"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/10447310802205776"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s44217-024-00195-7"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/10901981251327185"},{"key":"e_1_2_14_9_1","first-page":"189","volume-title":"Usability Evaluation in Industry","author":"Brooke J.","year":"1996"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.01017"},{"key":"e_1_2_14_11_1","doi-asserted-by":"crossref","unstructured":"Chen Y. 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