Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Over the past couple of decades, the utilization of simulation-based education in prelicensure nursing expanded in both frequency and functionality. Learning through simulation requires psychological safety where participants feel comfortable engaging to their fullest extent and can speak up or ask questions without fear of embarrassment to themselves or others. Professional simulation organizations provide recommendations for creating psychological safety, yet anecdotal stories from nurses report variability in their experiences ranging from positive to negative. Research regarding psychological safety in nursing education revealed some consistent themes of anxiety due to being observed or unfamiliar with simulation environments or expectations. The evolving literature also discussed some issues of anger, humiliation, and fear that result from participating in an environment that lacked psychological safety. Some of the findings were limited due to being at schools of nursing where the researchers were faculty for the population being studied and highly skilled in simulation pedagogy. The lack of understanding of the nurses’ perceptions of psychological safety and what factors could influence that feeling deserved further exploration. Seventeen recently graduated nurses were interviewed regarding their experiences with psychological safety during prelicensure simulation. Using Constructivist Grounded Theory, the data from these interviews were analyzed and the resultant theory was Simulation Psychological Safety Ecosystem. The theory explains that 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 simulation expectations, guidance from the instructor during scenarios, experience with watching and being watched by peers and faculty, and quality and tone of feedback received. The overall sense of psychological safety can also be influenced by nurses’ relationships with faculty and peers, and their desire to achieve meaningful clinical learning during the simulation. Findings of this study offer insight into the complex process of establishing, maintaining, and repairing psychological safety in prelicensure nursing simulation. The results are useful in guiding nursing education practices and suggest areas for future research.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Available for download on Saturday, October 11, 2025

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