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

Authors

Trakulwong Luecha, Charunyakorn Viriya, Nattaya Sangsai, Patcharin Poonthawe, Witchaporn Kidsamrong, Warisa Kanbuala, Puntaree Pikulnee, Paweena Tivasiripong

Published in

Advances in simulation (London, England). Jul 18, 2026. Epub Jul 18, 2026.

Abstract

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.
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.
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.
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.
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.

PMID:
42471664
Bibliographic data and abstract were imported from PubMed on 19 Jul 2026.

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