Promoting psychological safety in simulation using a novel visual tool: A mixed-methods quasi-experimental study

Psychological safety is imperative for effective simulation-based learning within healthcare education, yet it is challenging for educators to establish. A visual tool, “Simulation Tool to Enhance Psychological Safety” (STEPS) was incorporated into simulation-based activities for prelicensure nursing students to support (or strengthen) psychological safety. The purpose of this study was to determine the impact of the STEPS tool on psychological safety during simulated learning for prelicensure nursing students. This study used a quasi-experimental one-group pretest-posttest design using a mixed-methods approach. STEPS was implemented in 12 simulation activities throughout a semester at a School of Nursing located in the southeastern United States. The Psychological Safety in High Fidelity Simulation Scale was utilized as a pretest-posttest survey; open-ended survey responses and focus groups were collected at the end of the last simulated experience of the term. 51 prelicensure nursing students participated. Students' perceptions of psychological safety improved post the STEPS intervention. Qualitative data also revealed that they found STEPS valuable for enhancing learning from mistakes, support, comfort, and confidence. Students had different perceptions of how often STEPS needed to be explained. This study provides preliminary evidence that incorporating STEPS into simulated learning experiences as a visual reminder for students and faculty promotes a safe and supportive environment, which helps students redefine mistakes as learning opportunities. This tool may be used as part of a multi-pronged approach to promoting psychological safety. Further testing with larger sample sizes is needed to confirm these findings. •A visual tool may enhance psychological safety in simulation.•“STEPS” is an effective strategy to enhance Psychological Safety in simulation.•“STEPS” fostered feelings of support and confidence in students