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

Abstract

Aim: To clarify and define the concept of psychological harm in high-fidelity simulation.

Background: High-fidelity simulation is widely used in undergraduate nursing education to promote clinical competence and decision-making. While often beneficial, emotionally intense or poorly supported simulation experiences can result in psychological harm, an underrecognized phenomenon that may disrupt learning, self-efficacy, and professional development. Current literature lacks conceptual clarity to distinguish psychological harm from expected simulation-related stress.

Design: Concept analysis.

Methodology: A concept analysis was conducted using the method developed by Walker and Avant to explore psychological harm in the context of high-fidelity simulation.

Data sources: Peer-reviewed literature published between 2010 and 2025 was retrieved from MEDLINE, CINAHL, PsycINFO, and TRIP Pro. Inclusion criteria focused on articles that discussed psychological or emotional responses to high-fidelity simulation in healthcare education. Empirical peer-reviewed literature informed the identification of defining attributes, antecedents, and consequences. Practice-oriented documents and standards were reviewed to contextualize disciplinary usage; studies focused solely on technical skill acquisition were excluded.

Results: Three defining attributes were identified: (1) absence of psychological safety, (2) emotional disruption exceeding expected learning stress, and (3) sustained emotional impact beyond the simulation experience. Antecedents included emotionally intense content, insufficient preparation, unskilled facilitation, and performance-oriented learning environments. Consequences included diminished self-confidence, avoidance of future simulation, and impaired transfer of learning to clinical practice. Recent qualitative findings revealed that harm is often internalized and shaped by relational dynamics with simulationists and peers.

Conclusion: Psychological harm in high-fidelity simulation is a multidimensional, learner-dependent experience that can hinder both academic and professional development. This concept analysis offers a foundational definition and theoretical structure to support future research, education, and policy related to learner well-being in simulation.