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BACKGROUND: Nurses can play a valuable role in not only the implementation but development of general and health policies. However, evidence indicates limited involvement of nurses in politics and general health policy making owing to individual, interpersonal, and systematic barriers. INTRODUCTION: Strategies are required to increase nurses' participation and engagement in policymaking. However, no studies explored the perspective of nurse leaders in policy making roles and how to improve nurses' involvement in policy making. PURPOSE: To explore strategies to enhance nurses' involvement in policy making from the perspective of nurse leaders. METHODS: A qualitative descriptive study was conducted. Semistructured interviews were conducted with a purposive sample of 11 nurse leaders with at least one year of experience in policy making. Data were analyzed using a thematic analysis approach. The COREQ guidelines were followed for reporting. FINDINGS: Five themes were generated: strategically revisit and implement educational approaches, becoming transformative leaders, improving social image of nurses, developing triadic partnerships, and empowering nurses through reflective and supportive mechanisms. DISCUSSION: Nurses' involvement in policymaking can be enhanced by implementing grassroots-level educational strategies, managerial-level empowerment efforts, and social mechanisms focused on improving the social image of nursing. CONCLUSIONS: Self and professional role empowerment through education, increasing awareness, and improving the social image of nursing can boost nurses' involvement in policymaking. IMPLICATIONS FOR NURSING POLICY: Nurse leaders, national and global nursing associations, and nursing regulatory bodies should collaborate with associations of nursing colleges to design nurse policymaking competencies framework and contextually tailored strategies to enhance nurses' engagement in policymaking.

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AIMS: To explore the nurse managers' perspectives about the role and application of self-awareness in managerial practice. BACKGROUND: Effectively accomplishing complex roles and maintaining a healthy work environment requires nurse managers to be resilient and sustain positive relationships with nurses and interdisciplinary teams. Self-awareness is an essential attribute for building relationships and creating a healthier work environment. METHODS: A descriptive qualitative design was used. We conducted semi-structured interviews with a purposive sample of ten managers working in two tertiary hospitals. Reflexive thematic analysis was used for data analysis. RESULTS: Four themes were generated: "maximizing potential for overseeing complex management issues; becoming a conscientious and thoughtful manager; using experiential learning for nurturing managerial capabilities; and utilizing self and others' appraisal for discerning practical managerial approaches". CONCLUSIONS: Implementing self-awareness in complex situations is beneficial for nurse managers. It allows them to overcome negative emotions and factors and incorporate ethical and moral reasoning, thereby preventing them from ineffectual management. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should focus on assessing their temperaments and managerial abilities in each complex situation. They should use experiential learning from past experiences for discerning effective actions for managing complex situations.

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PURPOSE: To determine nurses' challenges, extent of involvement, and the impact of involvement in politics and policy making. ORGANIZING CONSTRUCT: Nurses in politics and health policy making. METHODS: Literature was searched in PubMed, Scopus, Google Scholar, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVID, and Open Grey using phrases comprising the following key words: "nurses", "policy making", "politics", "health policy", "nurses involvement in policy making/politics/health policy", "nurses challenges in policy making/politics/policy", and "impact of nursing policy making/politics/health policy"; 22 articles published from January 2000 to May 2019 were included. FINDINGS: The major challenges included intra- and interprofessional power dynamics, marginalization of nurses in policy making, and nursing profession-specific challenges. The extent of involvement was inadequate, and nurses mainly worked as policy implementers rather than as policy developers. Those nurses who participated in policy development focused on health promotion to build healthy communities and to empower nurses and the nursing profession. CONCLUSIONS: Nurses' involvement in policy making has not improved over time. Nursing institutions and regulatory bodies should prepare and encourage nurses to work as policymakers rather than implementers and advocate for the rightful place of nurses at policy-making forums. CLINICAL RELEVANCE: Preparation for health system policy making starts in the clinical settings. Educational institutions and nurse leaders should adequately prepare nurses for policy making, and nurses should participate in policy making at the organization, system, and national levels.

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Self-awareness is an essential nursing competency and there is limited knowledge about nurses' levels and application of self-awareness and instruments to measure nursing-specific self-awareness. Using mixed methods, we developed and tested a scale to measure nurses' self-awareness. First, 13 nurses were interviewed to understand their meanings of self-awareness and to develop nursing-specific self-awareness scale. Qualitative analysis generated professional, personal, contextual, and contentious aspects of self-awareness. Second, a 25-item scale assessed through expert consultations and pilot testing with 252 nurses. The content validity index was 0.94. After psychometric testing, seven items were deleted. Cronbach's alpha for the 18-item scale was 0.87 and the four-factor structure accounted for 45.55% of the variance. Lastly, the final scale was administered to 216 nurses. Nurses' had moderate self-awareness (59.65 ± 7.01), significantly associated with age and years of the clinical and educational experience. Intensive care nurses were more self-aware than nurses in other settings.

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AIMS: To discuss and illustrate how meaningful integration can be achieved in instrument development design. DESIGN: Discussion paper. DATA SOURCES: A mixed-methods study about challenges of nurse educators in Pakistan. The building technique was implemented when the findings of the qualitative phase were integrated to develop an instrument to determine educators' challenges while teaching nursing students in academic and clinical settings. IMPLICATIONS FOR NURSING: Nurses are required to use cultural- and population-specific instruments for data collection. The six-step building approach can enable nurses to develop such instruments using rigorous and robust mixed-methods design. CONCLUSION: Building and merging techniques are used in instrument development design during and after the completion of the study, respectively. However, building technique is essential for using the qualitative findings to develop the instrument. The proposed building approach starts with a robust qualitative data analysis and is strengthened with the selection of key themes and subthemes, linking them to the participants' quotes and then the conversion of the quotes into meaningful and pertinent items. Using the proposed building integration technique can enable researchers to meaningfully and efficiently use qualitative findings for developing instruments using mixed-methods designs. IMPACT: Mixed methods are valuable for the development of data collection instruments that are tailored to the study context and relevant for the study participants. There is limited guidance about how meaningful integration can be achieved when developing research instruments using mixed methods. We proposed a practical building technique that allows researchers to meaningfully use qualitative findings from one phase to develop an instrument for the subsequent phase. The proposed approach is useful for researchers aiming to develop data collection instruments using mixed methods.

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BACKGROUND: Organizational culture affects nurse educators' psychological empowerment. Limited research exists on the organizational culture and psychological empowerment in nursing educational environments and about the type of organizational factors affecting nurse educators' psychological empowerment. AIM: To explore nurse educators' perceived organizational factors that affect their psychological empowerment. METHODS: A qualitative descriptive exploratory study was drawn from a larger sequential exploratory-mixed-methods study. Semi-structured interviews were conducted with 12 educators with both clinical and educational experience. The data were analyzed using thematic analysis. RESULTS: We generated three themes: poor organizational structure, dynamics of educators-academic administrators' relations, and educational tools and physical environment. The educators perceived factors were poor organizational structure, lack of collaboration across institutions and regulatory bodies, condescending attitudes of administrators and educators toward novice educators, limited teaching aids and scholarly resources, poorly defined roles, and underdeveloped and inconsistent curricula. CONCLUSIONS: The identified organizational factors should be addressed to enhance educators' psychological empowerment so that they can effectively teach students. Emphasis should be placed on developing collaboration among educators, academic administrators, and regulatory bodies to address these factors. Further quantitative research is warranted to assess the degree and strength of association of these factors with psychological empowerment.

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BACKGROUND: Nurse educators are required to equip students with adequate theoretical and practical knowledge to provide effective nursing care. Limited studies have explored educators' challenges while teaching students. Existing studies are limited because of small sample, overreliance on qualitative approaches, and unreliable instruments that have not been tested. OBJECTIVES: To explore nurse educators' perspectives about their clinical and academic teaching, to develop a questionnaire to determine educators' challenges, and to develop a comprehensive understanding of educators' challenges. DESIGN: A sequential exploratory mixed-methods study. SETTINGS: Twelve nursing institutions in five cities of Pakistan. PARTICIPANTS: A purposive sample of 12 educators for interviews and 112 for the survey. METHODS: Semi-structured interviews and survey for data collection and expert consultations for questionnaire development. Thematic analysis for qualitative analysis, descriptive analysis for quantitative, and joint display tables for mixed methods. RESULTS: Educators experience workload and time constraints and struggle to effectively teach students due to inadequate student-educator ratio; underdeveloped curriculum; inadequate resources; inadequate clinical teaching settings for skills, simulation labs; inadequate professional development opportunities; lack of autonomous decision making; lack of educational, management, and research support from the regulatory bodies; and lack of educational research. CONCLUSIONS: Nurse educators' issues and challenges are persistent and require support from regulatory bodies and educational authorities. There is a need to develop policies to improve teaching and learning conditions for educators, provide them with the opportunities to enhance their own learning, and opportunities to collaborate with other educators in order to better prepare student nurses.

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Sometimes nurses are too harsh on themselves because they truly want to provide compassionate care for their patients. This attitude can lead to feelings of emptiness, hopelessness, incompetence, frustration, and despair. In such situations, nurses can improve their well-being by developing compassionate self-awareness-becoming aware of one's strengths and limitations without being over-critical and judgmental. This article describes the concept of compassionate self-awareness in light of the available anecdotal literature and personal experiences and argues that compassionate self-awareness can serve as a hidden resource for developing a therapeutic relationship with self and with patients.

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