Abstract

Background: Psychological safety (PS) is a critical determinant of effective simulation-based learning, enabling students to take interpersonal risks, engage authentically, and reflect without fear of judgment. While PS has been widely studied in traditional simulation, its application within virtual reality (VR) nursing education remains underexplored. As VR technologies expand rapidly in healthcare training, understanding how PS is defined, enacted, and challenged in this context is vital to optimizing both learning outcomes and learner well-being. Methods: A scoping review was conducted to map current evidence on PS in VR nursing simulations. Following Arksey and O’Malley’s (2005) and Levac et al.’s (2010) methodological frameworks, seven databases were systematically searched for studies published between 2015 and 2025. Ten peer-reviewed articles that met eligibility criteria were analyzed through thematic synthesis. Results: Findings revealed inconsistent definitions and conceptualizations of PS, ranging from emotional protection to inclusive, culturally responsive participation. Nine primary challenges were identified: insufficient facilitator training, mismatches in simulation fidelity (overwhelming or lacking realism), technological barriers, limited cultural humility, language-related constraints, reliance on self-report measures, small sample sizes, and restricted generalizability. Notably, few studies incorporated objective outcome measures or examined long-term impacts of VR on learner safety or performance. Conclusion: PS in VR nursing simulation is complex and context-dependent, requiring intentional instructional design, calibrated fidelity, culturally inclusive practices, and faculty skilled in digital facilitation. Institutional investment in infrastructure and training is equally crucial. Future research should prioritize longitudinal and mixed-methods studies, equity-driven frameworks, and validated tools to assess both subjective and objective learner experiences. Embedding PS as both a pedagogical and structural priority can ensure VR simulation serves as a psychologically safe, equitable, and transformative space for nursing education.