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Psychological Harm in High-Fidelity Simulation: A Concept Analysis.

Mohamed Toufic El Hussein1,2,3,4, Dawson S Sheehan1

  • 1Faculty of Health, Community and Education, School of Nursing and Midwifery, Mount Royal University, Calgary, Alberta, Canada, mtroyal.ca.

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PubMed
Summary

Psychological harm in high-fidelity simulation can disrupt learning and professional growth. Defining this harm is crucial for learner well-being in nursing education.

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Published on: March 8, 2018

Area of Science:

  • Nursing Education
  • Healthcare Simulation
  • Learner Well-being

Background:

  • High-fidelity simulation is vital in nursing education for developing clinical competence.
  • However, poorly managed simulations can cause psychological harm, impacting learning and self-efficacy.
  • A clear definition is needed to differentiate harm from normal simulation stress.

Purpose of the Study:

  • To clarify and define the concept of psychological harm within high-fidelity simulation contexts.
  • To establish a theoretical framework for understanding and addressing psychological harm in simulation.

Main Methods:

  • A concept analysis using Walker and Avant's method was performed.
  • Literature from 2010-2025 was systematically searched in databases like MEDLINE, CINAHL, PsycINFO, and TRIP Pro.
  • Inclusion criteria focused on psychological/emotional responses to simulation in healthcare education, excluding technical skill-only studies.

Main Results:

  • Three defining attributes of psychological harm identified: lack of psychological safety, emotional disruption beyond learning stress, and lasting emotional impact.
  • Antecedents include intense content, inadequate preparation, poor facilitation, and performance focus.
  • Consequences involve reduced confidence, simulation avoidance, and impaired clinical learning transfer.

Conclusions:

  • Psychological harm in high-fidelity simulation is complex and learner-specific, potentially impeding academic and professional progress.
  • This analysis provides a foundational definition and structure to guide future research, education, and policy on learner well-being in simulation.