Table 4.

Themes and sub-themes of factors affecting nurses participate in health policy making

Main themes	Sub-themes	Factors
Nursing related factors	Nurses’ viewpoints on policy making	• Lack of priority of health policy for nurses (1) • Not knowing the process of health policy as part of the tasks (1) • The existence of psychological issues in active participation (2) • Disapproval of nurses’ involvement in policymaking by others (2)
	Lack of proper reaction by nurses	• Fear of facing different perspectives (1) • Fear of confrontation with administration (1) • Feeling powerless (2) • Fear of facing new challenges (2)
	Gaining experience and skills	• Lack of skills to engage in process of health polices (5) • Building experience in the nursing (2) • Limited skills in public relations (3) • Improvement of their political skills (4) • Lack of research skills (4)
	Education and research system	• Lack of knowledge and education about the policy-making process (4) • Lack of understanding of a complex political process (4) • Lack of public understanding (3) • Lack of access to research resources (3) • Personal interest in political knowledge and information (3) • Integrating Political education in the design nursing curriculum (3) • Undertaking research in health policy (3) • General deficiencies in nursing education (2) • Inability of nurses to bring forward research evidence to inform policy formulation (1) • Clarity in research directions (1) • Building of supportive research environments (2) • Strengthening nurses’ research capacity (2) • Promotion of evidence based decision making in nursing practice (1) • Providing International training opportunities for research and policy formulation (1)
Management and organizational factors	Creating communication networks	• Lack of communication from the top down (4) • Lack of communication networks and bonding (2) • Lack of sense of teamwork and collegiality (3) • Lack of involvement with nursing organizations (1) • Lack of national nursing association (1) • Lack of professional interest groups (1) • Use of technology and informatics (2) • Lack of collective action amongst different nursing stakeholders (2) • Existence of unity (2)
	Gaining and sharing knowledge and information	• Lack of access to information (2) • Lack of university nursing academics (2) • Lack of college nursing educators (1) • Lack of information sharing (2) • Lack of sharing of policies (1) • Getting new ideas from nursing literature (1) • Utilizing evidence based information (2)
	Providing specialized and motivated human resources	• Lack of access to key individuals (2) • Increasing number of PhD nurses (1) • Having an organizational commitment (1) • Nurses motivation (1) • Shortage of nursing (2)
	Providing non-human resource	• Lack of time (5) • Lack of money and other resources (8)
	Establish effective leadership styles	• Combination of proactive leadership (1) • Leadership development among nurses (1)
	Establishment of incentive organizational structure	• Follow Health policy of top-down approach (2) • Lack of enabling structures (5) • Sufficient authority (1) • The existence of a hierarchical system (2) • Bottom-up approach (2) • Clinical governance (1) • Determining where the power lies in organizations (2)
	Membership in advisory and policy making committees	• Lack of nurses’ membership in the Policy development committee (1) • Membership in professional and or advocacy organizations (1)
	Health policy outcomes and impact	• Correct role playing of policy making by nurses (1) • Lack of health policy capacity (1) • Dispersion in making policies (1) • Different attitudes of health policy makers (2) • Failure to make a difference by political activities (2)
Work environment	Environmental elements	• Existence of mental health issues among nurses (2) • The negative image of nursing by others professions (3) • Creation of an enabling environment (2) • Creating more opportunities for participation of nurses (2)
	External support	• Lack of support from political sector (2) • Lack of support from government officials (1) • Lack of support from professional organizations (1) • Strong support from the national nursing association (1) • Non-academic view of some physicians on the field of nursing (2)
	Establishing fair and right work rules	• Heavy workload (2) • Career development of nurses (1) • Sex issues (2) • Restrictions of Nursing recruitment (1)