Simulation psychological safety ecosystem: using constructivist grounded theory to explore nurses’ experiences with prelicensure simulation

Abstract

Introduction Learning through simulation requires psychological safety where participants feel comfortable engaging to their fullest extent, speaking up or asking questions without fear of embarrassment. While professional simulation organizations provide recommendations on fostering psychological safety, anecdotal stories from newly graduated nurses demonstrated variability in their experiences. The study explored nurses’ experience with psychological safety in their prelicensure curricula. Methods Using constructivist grounded theory methodology, the researchers conducted 17 semi-structured interviews with nurses who had experienced simulation in their prelicensure curriculum. They collected and analysed data iteratively using constant comparison to identify categories and explore their relationships. They used theoretical sampling in later stages until data sufficiency was achieved. Results The constructed theory, Simulation Psychological Safety Ecosystem, expresses the variability of nurses’ experiences. Psychological safety is a dynamic, complex process with a spectrum of outcomes from feeling psychologically safe to suffering psychological harm. Factors that influence this outcome include clarification of Expectations, Facilitation from the instructor during scenarios, experience with Observation, and structure and quality of Debriefing/Feedback. Psychological safety is also influenced by nurses’ existing relationships with faculty and peers, and their desire to achieve meaningful clinical learning. Discussion Implications for nursing education reinforce clarifying expectations for equipment and roles, instructor presence, and observation. The findings suggest the benefits of establishing peer and faculty relationships prior to simulation-based education implementation and providing guidelines for faculty and peer feedback. Potential areas for future research include clarifying the ecosystem model and exploring the impact of faculty and peer relationships on psychological safety.