{"id":"https://openalex.org/W7225006880","doi":"https://doi.org/10.1016/j.ecns.2026.102089","title":"Implementing simulation-based education at scale: A realist evaluation of an institution-wide strategy","display_name":"Implementing simulation-based education at scale: A realist evaluation of an institution-wide strategy","publication_year":2026,"publication_date":"2026-10-31","ids":{"openalex":"https://openalex.org/W7225006880","doi":"https://doi.org/10.1016/j.ecns.2026.102089"},"language":"en","primary_location":{"id":"doi:10.1016/j.ecns.2026.102089","doi":"https://doi.org/10.1016/j.ecns.2026.102089","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.ecns.2026.102089","pdf_url":"https://www.nursingsimulation.org/article/S1876-1399(26)00187-8/pdf","source":{"id":"https://openalex.org/S204691484","display_name":"Clinical Simulation in Nursing","issn_l":"1876-1399","issn":["1876-1399","1876-1402"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-b","doyens","jufo-1","norway-1","poland-100","russia-white-list-1"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical Simulation in Nursing","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://www.nursingsimulation.org/article/S1876-1399(26)00187-8/pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5064894305","display_name":"James R. Naismith","orcid":"https://orcid.org/0009-0001-0285-0354","observed_orcids":["https://orcid.org/0009-0001-0285-0354"]},"institutions":[{"id":"https://openalex.org/I149672521","display_name":"Federation University","ror":"https://ror.org/05qbzwv83","country_code":"AU","type":"education","lineage":["https://openalex.org/I149672521"]}],"countries":["AU"],"is_corresponding":true,"raw_author_name":"James Naismith","raw_affiliation_strings":["Institute of Health and Wellbeing, Federation University, Berwick, Victoria, 3806, Australia"],"raw_orcid":"https://orcid.org/0009-0001-0285-0354","affiliations":[{"raw_affiliation_string":"Institute of Health and Wellbeing, Federation University, Berwick, Victoria, 3806, Australia","institution_ids":["https://openalex.org/I149672521"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5048740927","display_name":"Kerry Hood","orcid":"https://orcid.org/0000-0003-0666-8127","observed_orcids":["https://orcid.org/0000-0003-0666-8127"]},"institutions":[{"id":"https://openalex.org/I149672521","display_name":"Federation University","ror":"https://ror.org/05qbzwv83","country_code":"AU","type":"education","lineage":["https://openalex.org/I149672521"]}],"countries":["AU"],"is_corresponding":false,"raw_author_name":"Kerry Hood","raw_affiliation_strings":["Institute of Health and Wellbeing, Federation University, Berwick, Victoria, 3806, Australia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Institute of Health and Wellbeing, Federation University, Berwick, Victoria, 3806, Australia","institution_ids":["https://openalex.org/I149672521"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5041730338","display_name":"Wendy M Cross","orcid":"https://orcid.org/0000-0003-3297-0274","observed_orcids":["https://orcid.org/0000-0003-3297-0274"]},"institutions":[{"id":"https://openalex.org/I149672521","display_name":"Federation University","ror":"https://ror.org/05qbzwv83","country_code":"AU","type":"education","lineage":["https://openalex.org/I149672521"]}],"countries":["AU"],"is_corresponding":false,"raw_author_name":"Wendy Cross","raw_affiliation_strings":["Institute of Health and Wellbeing, Federation University, Berwick, Victoria, 3806, Australia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Institute of Health and Wellbeing, Federation University, Berwick, Victoria, 3806, Australia","institution_ids":["https://openalex.org/I149672521"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5071707537","display_name":"Loretta Garvey","orcid":"https://orcid.org/0000-0002-4985-4280","observed_orcids":["https://orcid.org/0000-0002-4985-4280"]},"institutions":[{"id":"https://openalex.org/I149672521","display_name":"Federation University","ror":"https://ror.org/05qbzwv83","country_code":"AU","type":"education","lineage":["https://openalex.org/I149672521"]}],"countries":["AU"],"is_corresponding":false,"raw_author_name":"Loretta Garvey","raw_affiliation_strings":["Institute of Health and Wellbeing, Federation University, Berwick, Victoria, 3806, Australia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Institute of Health and Wellbeing, Federation University, Berwick, Victoria, 3806, Australia","institution_ids":["https://openalex.org/I149672521"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5064894305"],"corresponding_institution_ids":["https://openalex.org/I149672521"],"apc_list":{"value":3210,"currency":"USD","value_usd":3210},"apc_paid":{"value":3210,"currency":"USD","value_usd":3210},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.85001667,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"120","issue":null,"first_page":"102089","last_page":"102089"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11238","display_name":"Simulation-Based Education in Healthcare","score":0.9868000149726868,"subfield":{"id":"https://openalex.org/subfields/2737","display_name":"Physiology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11238","display_name":"Simulation-Based Education in Healthcare","score":0.9868000149726868,"subfield":{"id":"https://openalex.org/subfields/2737","display_name":"Physiology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10254","display_name":"Innovations in Medical Education","score":0.008799999952316284,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10629","display_name":"Health Policy Implementation Science","score":0.0024999999441206455,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/simulation-based-education","display_name":"simulation-based education","score":0.9990000128746033},{"id":"https://openalex.org/keywords/health-professions-education","display_name":"health professions education","score":0.777999997138977},{"id":"https://openalex.org/keywords/institutional-implementation","display_name":"institutional implementation","score":0.6420000195503235},{"id":"https://openalex.org/keywords/organizational-readiness","display_name":"organizational readiness","score":0.847000002861023},{"id":"https://openalex.org/keywords/organizational-culture","display_name":"organizational culture","score":0.503000020980835},{"id":"https://openalex.org/keywords/multi-campus-universities","display_name":"multi-campus universities","score":0.6949999928474426},{"id":"https://openalex.org/keywords/sustainability-planning","display_name":"sustainability planning","score":0.5649999976158142},{"id":"https://openalex.org/keywords/faculty-development","display_name":"faculty development","score":0.6330000162124634},{"id":"https://openalex.org/keywords/curriculum-integration","display_name":"curriculum integration","score":0.9120000004768372},{"id":"https://openalex.org/keywords/governance","display_name":"governance","score":0.6579999923706055},{"id":"https://openalex.org/keywords/psychological-safety","display_name":"psychological safety","score":0.8309999704360962},{"id":"https://openalex.org/keywords/context-mechanism-outcome","display_name":"context-mechanism-outcome","score":0.734000027179718}],"concepts":[{"id":"https://openalex.org/C44725695","wikidata":"https://www.wikidata.org/wiki/Q288156","display_name":"Normative","level":2,"score":0.5838000178337097},{"id":"https://openalex.org/C2779343474","wikidata":"https://www.wikidata.org/wiki/Q3109175","display_name":"Context (archaeology)","level":2,"score":0.565500020980835},{"id":"https://openalex.org/C47177190","wikidata":"https://www.wikidata.org/wiki/Q207137","display_name":"Curriculum","level":2,"score":0.5375000238418579},{"id":"https://openalex.org/C201305675","wikidata":"https://www.wikidata.org/wiki/Q852998","display_name":"Stakeholder","level":2,"score":0.5365999937057495},{"id":"https://openalex.org/C56739046","wikidata":"https://www.wikidata.org/wiki/Q192060","display_name":"Knowledge management","level":1,"score":0.5328999757766724},{"id":"https://openalex.org/C66204764","wikidata":"https://www.wikidata.org/wiki/Q219416","display_name":"Sustainability","level":2,"score":0.5311999917030334},{"id":"https://openalex.org/C14036430","wikidata":"https://www.wikidata.org/wiki/Q3736076","display_name":"Function (biology)","level":2,"score":0.43970000743865967},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.40790000557899475},{"id":"https://openalex.org/C144024400","wikidata":"https://www.wikidata.org/wiki/Q21201","display_name":"Sociology","level":0,"score":0.3917999863624573},{"id":"https://openalex.org/C179454799","wikidata":"https://www.wikidata.org/wiki/Q132151","display_name":"Ethnography","level":2,"score":0.3790999948978424},{"id":"https://openalex.org/C22467394","wikidata":"https://www.wikidata.org/wiki/Q849359","display_name":"Multidisciplinary approach","level":2,"score":0.3564999997615814},{"id":"https://openalex.org/C67674302","wikidata":"https://www.wikidata.org/wiki/Q730573","display_name":"Organizational culture","level":2,"score":0.3474999964237213},{"id":"https://openalex.org/C19417346","wikidata":"https://www.wikidata.org/wiki/Q7922","display_name":"Pedagogy","level":1,"score":0.3398999869823456},{"id":"https://openalex.org/C120912362","wikidata":"https://www.wikidata.org/wiki/Q136822","display_name":"Higher education","level":2,"score":0.3368000090122223},{"id":"https://openalex.org/C169735623","wikidata":"https://www.wikidata.org/wiki/Q1430172","display_name":"Organizational learning","level":2,"score":0.31459999084472656},{"id":"https://openalex.org/C55587333","wikidata":"https://www.wikidata.org/wiki/Q1133029","display_name":"Engineering ethics","level":1,"score":0.31139999628067017},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.2782000005245209},{"id":"https://openalex.org/C182566","wikidata":"https://www.wikidata.org/wiki/Q759524","display_name":"Organizational structure","level":2,"score":0.2678000032901764},{"id":"https://openalex.org/C2780801425","wikidata":"https://www.wikidata.org/wiki/Q5164392","display_name":"Construct (python library)","level":2,"score":0.2597000002861023}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1016/j.ecns.2026.102089","doi":"https://doi.org/10.1016/j.ecns.2026.102089","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.ecns.2026.102089","pdf_url":"https://www.nursingsimulation.org/article/S1876-1399(26)00187-8/pdf","source":{"id":"https://openalex.org/S204691484","display_name":"Clinical Simulation in Nursing","issn_l":"1876-1399","issn":["1876-1399","1876-1402"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-b","doyens","jufo-1","norway-1","poland-100","russia-white-list-1"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical Simulation in Nursing","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.1016/j.ecns.2026.102089","doi":"https://doi.org/10.1016/j.ecns.2026.102089","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.ecns.2026.102089","pdf_url":"https://www.nursingsimulation.org/article/S1876-1399(26)00187-8/pdf","source":{"id":"https://openalex.org/S204691484","display_name":"Clinical Simulation in Nursing","issn_l":"1876-1399","issn":["1876-1399","1876-1402"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-b","doyens","jufo-1","norway-1","poland-100","russia-white-list-1"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical Simulation in Nursing","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Quality education","score":0.9235000014305115,"id":"https://metadata.un.org/sdg/4"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225006880.pdf","grobid_xml":"https://content.openalex.org/works/W7225006880.grobid-xml"},"referenced_works_count":26,"referenced_works":["https://openalex.org/W2464700444","https://openalex.org/W2552779778","https://openalex.org/W2790982903","https://openalex.org/W2800031689","https://openalex.org/W2974974027","https://openalex.org/W3017060626","https://openalex.org/W3105724865","https://openalex.org/W3120522656","https://openalex.org/W3133567591","https://openalex.org/W3201549456","https://openalex.org/W4226284132","https://openalex.org/W4307846395","https://openalex.org/W4379471116","https://openalex.org/W4383557002","https://openalex.org/W4387380791","https://openalex.org/W4394741430","https://openalex.org/W4396975747","https://openalex.org/W4401073830","https://openalex.org/W4404393565","https://openalex.org/W4404712233","https://openalex.org/W4406712368","https://openalex.org/W4410503350","https://openalex.org/W4412368569","https://openalex.org/W4412540391","https://openalex.org/W4414439860","https://openalex.org/W7171540785"],"related_works":["https://openalex.org/W3017060626","https://openalex.org/W7171540785","https://openalex.org/W2884348117","https://openalex.org/W4410268632","https://openalex.org/W4417162521","https://openalex.org/W4414439860","https://openalex.org/W3136196815","https://openalex.org/W7203684250","https://openalex.org/W7164025781","https://openalex.org/W2169104763"],"abstract_inverted_index":{"Background":[0],"Simulation-based":[1],"education":[2,164],"(SBE)":[3],"is":[4,26,30],"widely":[5],"embedded":[6],"in":[7,19,37,127,161],"health":[8],"professions":[9],"education;":[10],"however,":[11],"institution-wide":[12,46],"implementation":[13,160],"and":[14,69,78,114,130,143],"sustainability":[15,115],"remain":[16],"challenging,":[17],"particularly":[18],"large,":[20],"multi-campus":[21],"universities.":[22],"While":[23],"pedagogical":[24],"effectiveness":[25],"well":[27],"established,":[28],"less":[29],"known":[31],"about":[32],"how":[33,44,107],"organizational":[34,70,141],"strategies":[35],"function":[36],"practice.":[38],"This":[39],"study":[40],"aimed":[41],"to":[42,156],"explain":[43],"an":[45],"SBE":[47,159],"strategy":[48,148],"was":[49,62],"implemented":[50],"using":[51,83],"a":[52],"realist":[53,58],"evaluation":[54],"lens.":[55],"Methods":[56],"A":[57],"evaluation\u2013informed":[59],"mixed-methods":[60],"design":[61],"employed.":[63],"Organizational":[64,88],"readiness":[65,71,89,99],"data":[66],"(simulation":[67],"culture":[68],"survey;":[72],"SCORS),":[73],"document":[74],"analysis,":[75],"ethnographic":[76],"observations,":[77],"stakeholder":[79],"discussions":[80],"were":[81,136],"synthesized":[82],"context\u2013mechanism\u2013outcome":[84],"(CMO)":[85],"logic.":[86],"Results":[87],"demonstrated":[90],"strong":[91],"normative":[92],"support":[93,157],"for":[94,100],"simulation":[95,128],"but":[96],"low":[97],"structural":[98],"coordinated":[101],"delivery.":[102],"Seven":[103],"CMO":[104],"configurations":[105],"explained":[106],"centralization,":[108],"governance,":[109],"curriculum":[110],"integration,":[111],"faculty":[112],"development,":[113],"planning":[116],"generated":[117],"outcomes":[118,135],"through":[119],"mechanisms":[120],"including":[121],"legitimacy,":[122],"accountability,":[123],"psychological":[124],"safety,":[125],"confidence":[126],"practice,":[129],"future-oriented":[131],"motivation.":[132],"Conclusion":[133],"Implementation":[134],"shaped":[137],"by":[138],"interactions":[139],"between":[140],"context":[142],"staff":[144],"reasoning":[145],"rather":[146],"than":[147],"alone.":[149],"These":[150],"findings":[151],"provide":[152],"transferable,":[153],"theory-informed":[154],"explanations":[155],"sustainable":[158],"complex":[162],"higher":[163],"settings.":[165]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-11-01T00:00:00"}