Thai nursing students' experiences of stress, role positioning, and facilitation tone in simulation-based learning: implications for culturally responsive facilitation and debriefing.

Abstract

Background: Simulation facilitation models have developed predominantly in Western educational settings. The ways in which cultural norms, particularly kreng-jai and deference to authority, shape nursing student participation in high power-distance contexts have received limited empirical attention.

Objectives: This study examined how stress, role positioning, and facilitator feedback timing and tone interact to shape participation and culturally safe learning in simulation-based nursing education in Thailand.

Methods: Semi-structured interviews were conducted in Thai with 24 third- and fourth-year nursing students in Eastern Thailand between August and October 2024. Interviews lasted 45-60 min and were analysed using reflexive thematic analysis.

Results: Four themes were developed. Entering a New Space positioned simulation as a threshold where visibility intersected with kreng-jai-patterned restraint; students' reluctance to speak was culturally rational rather than disengagement. Stress as a Double-Edged Sword in Simulation showed that pressure could sharpen recall and prioritisation but could also narrow participation when abrupt feedback arrived mid-scenario. Learning Across Participation, Observation, and Debriefing identified distinct but complementary learning routes: active scenario participants acted under time pressure, whereas observers developed an analytic perspective, with both perspectives converging during debriefing. Facilitation and Cultural Safety found that calm guidance kept kreng-jai compatible with engagement, whereas abrupt correction rendered silence a response to relational risk.

Conclusion: Participation and psychological safety in simulation were not inherent features of instructional design but were interactionally and culturally mediated through facilitation, role positioning, and hierarchical norms.