Abstract
<title>Abstract</title> <p>Background Artificial intelligence (AI), particularly large language models and AI-generated health information, is reshaping how patients access and interpret health information before clinical encounters. As patients increasingly enter healthcare with pre-formed understandings shaped by AI-mediated information, clinical communication is becoming more interpretive, relational, and complex. However, little empirical evidence has examined how nursing students experience and interpret these changing communication practices during authentic clinical placement. This study explored how nursing students experienced and interpreted AI-mediated clinical communication during clinical placement, guided by the concepts of interpretive authority, professional responsibility, and uncertainty communication. Methods A theory-informed qualitative exploratory study was conducted with 32 Year 3 undergraduate nursing students undertaking surgical clinical placement at a university-affiliated teaching hospital. Participants completed structured reflective logs during placement and participated in facilitated post-placement reflective discussions. Data were analysed using reflexive thematic analysis. Results Four themes were identified: (1) encountering AI-informed patient understanding; (2) negotiating patient understanding in clinical communication; (3) communicating uncertainty in nursing practice; and (4) reframing the communicative role of nurses. Participants described communication encounters shaped by AI-generated or digitally mediated information, highlighting challenges associated with differing interpretations, communicating uncertainty, and maintaining therapeutic relationships. Clinical communication was increasingly understood as an interpretive and relational aspect of nursing practice that extends beyond the transmission of clinical information. Conclusions AI-mediated communication is reshaping patient understanding, clinical communication, and the communicative role of nurses in contemporary healthcare. Authentic clinical placement provided nursing students with opportunities to observe and interpret these changing communication practices, contributing to professional understanding of interpretive authority, professional responsibility, and uncertainty communication. These findings highlight the importance of preparing future nurses for the interpretive, relational, and communication demands of AI-mediated healthcare.</p>