Trainee nurses and midwives’ perception and experiences of psychological safety and interactive communication in the classroom and clinical settings in Ghana

BACKGROUND: Psychological safety is essential for effective learning, communication, and professional development in nursing and midwifery education. Environments lacking psychological safety hinder student engagement, reduce confidence, and negatively affect learning outcomes. Despite its importance, the concept remains underexplored in African educational and clinical contexts. This study examined trainee nurses' and midwives' perceptions and experiences of psychological safety and interactive communication in classroom and clinical settings in Ghana. METHODS: An embedded mixed-methods cross-sectional design guided by Good Reporting of a Mixed-Method Study (GRAMMS) checklist and Edmondson's Psychological Safety Theory was employed. A total of 169 students were recruited using purposive and convenience sampling. Data were collected using a structured questionnaire adapted from Edmondson's psychological safety scale (α = 0.79) with embedded open-ended questions. Quantitative data were analyzed using SPSS version 27, while qualitative data were analyzed using Braun and Clarke's Thematic Analysis. Psychological safety levels were categorized as low (1.0-2.9), moderate (3.0-3.9), and high (≥ 4.0). RESULTS/ FINDINGS: Students reported moderate psychological safety in classroom settings (mean = 3.42, SD = 0.79) and lower psychological safety in clinical settings (mean = 3.05, SD = 0.86). Approximately 70% felt comfortable asking questions in class, while 49% reported fear of public reprimand during clinical training. Respectful communication, supportive supervision, and peer collaboration enhanced psychological safety, whereas hierarchical relationships, negative feedback practices, and fear of embarrassment hindered it. CONCLUSION: Psychological safety varies across learning environments, with clinical settings presenting greater challenges. Institutional strategies should prioritize mentorship, supportive supervision, and communication training to improve learning outcomes and professional development.