Table of Contents
Abstract
The Psychological safety in High-fidelity simulation Scale – Japanese Version (PS-HFS-J) is a specialized psychometric instrument designed to quantify the degree of Psychological safety experienced by nursing Students during immersive clinical simulations. Originally conceptualized in Korea, this tool was rigorously adapted for Japanese educational contexts to account for distinct cultural nuances in communication, hierarchy, and learning behaviors. Psychological safety—the belief that one will not be penalized or humiliated for making mistakes or asking questions—is a critical prerequisite for effective experiential learning. When Students feel psychologically secure, they are more likely to engage deeply with high-fidelity simulations, leading to better clinical reasoning and skill acquisition.
The adaptation process adhered strictly to the COSMIN guidelines, ensuring a robust cross-cultural translation. The resulting 14-item scale captures four distinct dimensions of the learner's emotional experience: navigating uncertainty, feelings of exposure, perceived lack of support, and interpersonal risk. By providing a validated metric for these domains, the PS-HFS-J equips educators and researchers with the means to objectively evaluate the learning environment.
Ultimately, the introduction of this validated Japanese instrument fills a significant methodological gap in Nursing education research within Japan. It allows academic institutions to systematically assess how instructional design, debriefing techniques, and faculty interactions impact student vulnerability and confidence. This capability is essential for optimizing simulation-based curricula and fostering a supportive atmosphere that maximizes educational outcomes.
📊 Psychometric Scorecard
14
Multidimensional
0.91
0.990
📍 Japan
Authors
Purpose
High-fidelity simulation is an incredibly powerful pedagogical tool, but it inherently places learners in vulnerable positions where their clinical knowledge and decision-making are scrutinized. This exposure can trigger significant anxiety and a fear of negative evaluation, which paradoxically inhibits the very learning the simulation is meant to facilitate. The PS-HFS-J was developed to provide a standardized, culturally attuned method for measuring this specific vulnerability—Psychological safety—among Japanese nursing Students.
Prior to the validation of this scale, educators in Japan lacked a psychometrically sound tool to assess whether their simulation environments were truly conducive to open learning and risk-taking. By quantifying Psychological safety, the PS-HFS-J allows faculty to identify instructional gaps, tailor their prebriefing and debriefing strategies, and ultimately design simulations that prioritize emotional security alongside clinical rigor. This is vital for transitioning Students from passive observers to active, confident clinical decision-makers.
Construct
The core construct measured by the PS-HFS-J is Psychological safety within the specific context of high-fidelity clinical simulations. In broader organizational psychology, Psychological safety refers to a shared belief that a team is safe for interpersonal risk-taking. In the educational simulation context, it translates to a student's perception that they can make clinical errors, ask naive questions, or express uncertainty without facing ridicule, harsh grading, or damage to their professional reputation.
The scale operationalizes this construct through a multidimensional framework comprising four distinct sub-domains. 'Dealing with Uncertainty' captures the learner's comfort level when facing ambiguous clinical scenarios. 'Being Exposed' reflects the vulnerability felt when one's actions are observed and evaluated by peers and instructors. 'Being Unsupported' measures the perceived lack of guidance or psychological backing from the educational team. Finally, 'Interpersonal Risk' assesses the fear of negative social consequences, such as peer judgment or instructor disapproval, which can stifle active participation.
Validity
To establish the validity of the PS-HFS-J, the research team employed a comprehensive, multi-stage approach grounded in the COSMIN framework. Content validity was rigorously evaluated through expert panel reviews and pilot testing with Students, ensuring that the translated items were both culturally appropriate and conceptually equivalent to the original scale. The item-level content validity indices (I-CVI) were exceptionally strong, ranging from 0.80 to 1.00, while the scale-level index (S-CVI/Ave) reached 0.94, indicating that the items highly accurately represent the target construct.
Construct validity was subsequently confirmed through confirmatory factor analysis (CFA) on a sample of 263 undergraduate nursing Students. The analysis tested the hypothesized four-factor structure and yielded excellent model fit indices. Specifically, the Comparative Fit Index (CFI) was 0.990 and the Tucker-Lewis Index (TLI) was 0.988, both well above the stringent 0.95 threshold for excellent fit. Furthermore, the Root Mean Square Error of Approximation (RMSEA) was remarkably low at 0.026, providing robust statistical evidence that the Japanese adaptation maintains the structural integrity of the original instrument.
Reliability
The reliability of the PS-HFS-J was demonstrated through both internal consistency and temporal stability metrics, confirming it as a highly dependable measurement tool. Internal consistency, which assesses how well the items within the scale correlate with one another, was excellent. The overall scale achieved a Cronbach's alpha of 0.906, easily surpassing the conventional benchmark of 0.70 required for research and educational applications, and indicating that the items reliably measure the same underlying construct.
To ensure that the scale produces stable measurements over time, test-retest reliability was evaluated using a subsample of 52 Students. The resulting Intraclass Correlation Coefficients (ICC) for the subscales ranged from 0.859 to 0.914. In psychometric terms, ICC values in this range are considered good to excellent, demonstrating that Students' scores remain consistent across multiple administrations when the underlying learning environment has not changed. This temporal stability is particularly crucial for educators who wish to use the scale longitudinally to track changes in Psychological safety across a semester.
Factor Analysis
The structural architecture of the PS-HFS-J was evaluated using Confirmatory Factor Analysis (CFA) with maximum likelihood estimation. This analytical technique is essential for verifying whether the empirical data collected from the Japanese sample aligns with the theoretical four-factor model established by the original scale developers. By constraining the items to load only on their respective hypothesized dimensions, the researchers could rigorously test the multidimensionality of the Psychological safety construct in this new cultural context.
The results of the CFA provided compelling evidence for the four-factor model. The chi-square test yielded a non-significant result (p = 0.142), which is a strong initial indicator of good model fit, especially given the sample size. More importantly, the absolute and incremental fit indices were exemplary. The model produced a CFI of 0.990, a TLI of 0.988, and an RMSEA of 0.026 with a tight 90% confidence interval (0.000–0.060). These metrics collectively confirm that the 14 items cleanly separate into the four distinct domains of Dealing with Uncertainty, Being Exposed, Being Unsupported, and Interpersonal Risk, without problematic cross-loadings.
Subscales
| Subscale | Items | Description |
|---|---|---|
| Dealing with Uncertainty | Measures the learner's comfort level and psychological security when facing ambiguous or unpredictable clinical scenarios during simulation. | |
| Being Exposed | Assesses the feelings of vulnerability and self-consciousness experienced when a student's clinical performance is observed by others. | |
| Being Unsupported | Evaluates the student's perception of lacking adequate guidance, encouragement, or psychological backing from instructors and peers. | |
| Interpersonal Risk | Captures the fear of negative social consequences, such as peer judgment or instructor disapproval, resulting from active participation or making mistakes. |
Instrument
| Test Type | Self-report questionnaire |
| Format | 14 items |
| Language | Japanese |
| Population | College students, Nurses, Students |
| Administration | Online survey |
Psychological Safety in High-Fidelity Simulation Scale – Japanese Version Items
Items are currently not available
The individual items of this scale are not publicly available. Researchers interested in using this instrument should contact the original authors directly to request the scale materials.
Sample
The validation sample consisted of 263 undergraduate nursing Students in Japan. The cohort included 44 first-year (16.7%), 62 second-year (23.6%), 88 third-year (33.5%), and 69 fourth-year Students (26.2%). A subsample of 52 Students participated in the test-retest reliability phase.
Permissions & Test Year
Permission to translate and adapt the original scale into Japanese was obtained from the original developer.
Test Year: 2025
Cite This Paper
Keisuke Nojima, Makoto Tsukuda, Kosuke Kawamura, Junko Honda, Mie Murozumi (2025). Psychological safety in High-fidelity simulation Scale – Japanese Version. Nursing reports (Pavia, Italy). https://doi.org/10.3390/nursrep15070257
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Cite this article
Mohammed looti (2026). Psychological Safety in High-Fidelity Simulation Scale – Japanese Version. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/psychological-safety-in-high-fidelity-simulation-scale-japanese-version/
Mohammed looti. "Psychological Safety in High-Fidelity Simulation Scale – Japanese Version." PSYCHOLOGICAL SCALES, 14 Aug. 2026, https://scales.arabpsychology.com/s/psychological-safety-in-high-fidelity-simulation-scale-japanese-version/.
Mohammed looti. "Psychological Safety in High-Fidelity Simulation Scale – Japanese Version." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/psychological-safety-in-high-fidelity-simulation-scale-japanese-version/.
Mohammed looti (2026) 'Psychological Safety in High-Fidelity Simulation Scale – Japanese Version', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/psychological-safety-in-high-fidelity-simulation-scale-japanese-version/.
[1] Mohammed looti, "Psychological Safety in High-Fidelity Simulation Scale – Japanese Version," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.
Mohammed looti. Psychological Safety in High-Fidelity Simulation Scale – Japanese Version. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.