Abstract

Background/Objectives: Nursing informatics (NI) competence is becoming increasingly essential for nursing students; however, previous research has largely relied on quantitative surveys and provided limited insights into why positive attitudes may not be accompanied by practical competence. This study examined Chinese undergraduate nursing students’ self-assessed NI competence and qualitatively explored their conceptual understanding, perceptions, and experiences related to NI and digital health. Methods: A convergent parallel mixed-methods design was employed in Guangzhou, China. Quantitative data were collected from 149 undergraduate nursing students across two nursing schools using the Chinese Self-Assessment of Nursing Informatics Competencies Scale (SANICS), whereas qualitative data were gathered from 23 students at one of the participating schools through six semi-structured focus groups. Quantitative data were analyzed using descriptive statistics and exploratory Spearman correlations, while qualitative data were analyzed thematically. Findings from both strands were integrated during interpretation using a joint display matrix. Results: The mean self-assessed NI competence score was 2.78 ± 0.54 (scale 1–5). Among the five SANICS subscales, attitudes toward NI scored highest (4.16 ± 0.76), whereas applied computer skills scored lowest (2.02 ± 0.80), confirming an attitude-competence paradox. Exploratory correlation analyses showed neither year of study nor clinical exposure was significantly associated with the total competence score, although both were negatively associated with attitudes. Three qualitative themes contextualized this paradox: (1) a fragmented conceptual understanding centered primarily on basic functions and tools; (2) positive but cautious perceptions that recognized the value of NI while expressing concerns about humanistic care; and (3) passive skill acquisition, limited hands-on learning, and insufficient awareness of higher-order informatics roles. Conclusions: In this two-school sample, students valued NI but reported limited applied and clinically situated competence. The findings suggest that curricula should move beyond generic computer courses and unstructured exposure toward practice-embedded NI education, including electronic health record simulation, digital documentation, data security, and clinically relevant digital skills.

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