Pedagogical Strategies for Enhancing Critical Thinking in Nursing Students Using Large Language Models: A Mixed-Methods Systematic Review Protocol
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Oh, Lucy
Mearns, Gael
Mowat, Rebecca
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BMJ
Abstract
Introduction: Large language models (LLMs) are rapidly normalising in nursing education. However, evidence regarding their impact on critical thinking—a cornerstone of safe clinical practice—remains inconsistent. Current syntheses have largely focused on student satisfaction and general utility, leaving the specific instructional mechanisms that cultivate this competency unexplored. This mixed-methods systematic review aims to identify effective pedagogical strategies for fostering critical thinking, providing evidence-based guidance to safeguard clinical competency in an artificial intelligence-integrated workforce.
Methods and analysis: This review will follow a convergent segregated mixed-methods design in accordance with the Joanna Briggs Institute (JBI) methodology. A systematic search will be conducted across CINAHL, ERIC, MEDLINE, PsycINFO and Scopus supplemented by grey literature sources (ProQuest Dissertations, MedRxiv). The search will be limited to English-language studies published from January 2023 to June 2026. Eligible studies will include undergraduate nursing students exposed to structured LLM-based pedagogical interventions. Methodological quality will be appraised using design-specific JBI Critical Appraisal Checklists. Outcomes will be classified using a modified Kirkpatrick framework to distinguish objective competence from subjective confidence. Quantitative data will be synthesised narratively following Synthesis Without Meta-analysis guidelines, and qualitative data thematically. Streams will be integrated using a Joint Display Analysis to generate meta-inferences on effective instructional design. Finally, confidence in the cumulative evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) and GRADE-Confidence in the Evidence from Reviews of Qualitative research.
Ethics and dissemination: As a systematic review of existing literature, this study does not require ethical approval. Findings will be disseminated through a peer-reviewed publication, conference presentations and a visual guide for educators.
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1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences, 32 Biomedical and clinical sciences, 42 Health sciences, 52 Psychology
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BMJ Open, ISSN: 2044-6055 (Print); 2044-6055 (Online), BMJ, 16(7), e119386-e119386. doi: 10.1136/bmjopen-2026-119386
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CC-BY_NC Creative Commons Attribution Non Commercial
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. Open Access.
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. Open Access.
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Except where otherwise noted, this item's license is described as CC-BY_NC Creative Commons Attribution Non Commercial