Automated Procedural Analysis via Video-Language Models for AI-assisted Nursing Skills Assessment

Consistent high-quality nursing care is essential for patient safety, yet current nursing education depends on subjective, time-intensive instructor feedback in training future nurses, which limits scalability and efficiency in their training, and thus hampers nursing competency when they enter the workforce. In this paper, we introduce a video-language model (VLM) based framework to develop the AI capability of automated procedural assessment and feedback for nursing skills training, with the potential of being integrated into existing training programs. Mimicking human skill acquisition, the framework follows a curriculum-inspired progression, advancing from high-level action recognition, fine-grained subaction decomposition, and ultimately to procedural reasoning. This design supports scalable evaluation by reducing instructor workload while preserving assessment quality. The system provides three core capabilities: 1) diagnosing errors by identifying missing or incorrect subactions in nursing skill instruction videos, 2) generating explainable feedback by clarifying why a step is out of order or omitted, and 3) enabling objective, consistent formative evaluation of procedures. Validation on synthesized videos demonstrates reliable error detection and temporal localization, confirming its potential to handle real-world training variability. By addressing workflow bottlenecks and supporting large-scale, standardized evaluation, this work advances AI applications in nursing education, contributing to stronger workforce development and ultimately safer patient care.