Explaining the position of aesthetics in Iran’s nursing leadership

Explaining the position of aesthetics in Iran’s nursing leadership | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Explaining the position of aesthetics in Iran’s nursing leadership newsha poursaadat, mohammad ali cheraghi, Maryam Esmaeili, fatemeh hajibabaee This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5296193/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and objective: Aesthetics can be explained and investigated in two contexts of beauty and sublimity. Aesthetics is often considered as a specific method of sensory perception or experience. Findings of qualitative studies should be used to objectify aesthetics in all areas of nursing, including management and leadership. This study was conducted in 2023 to explain the position of aesthetics in Iran’s nursing leadership in the teaching hospitals of Tehran University of Medical Sciences. Method: This is a descriptive and qualitative study with conventional content analysis approach suggested by Granheim and Lundman. Research community included the leadership and management team of hospitals affiliated to Tehran University of Medical Sciences. Semi-structured and face-to-face individual interviews (28 in total) were conducted with the participants ( director nurses and supervisors and head nurses) to collect the data. purposeful and snowball methods were used for the sampling, which continued until data saturation. Findings : A total of 1482 codes were extracted from 28 interviews, which were later summarized in three main categories (aesthetic thought, aesthetic speech and aesthetic action) and nine subcategories. Conclusion: This study consolidates the findings of previous studies in terms of theoretical foundations of aesthetic leadership in the literature, and in regard to methodology, it facilitates the complementation of aesthetic nursing leadership model in the health care system. Therefore, it can help to objectify and explain the concepts of beauty and sublimity in the organizational life of nursing leaders in Iran's health care system. Aesthetics leadership nursing 1. Introduction The Greek word “aesthetic” refers to any sensory experience, regardless of being sensory, perceptual or artistic. Aesthetics drives from experience-based feelings and perceptions [ 1 ]. Implicit knowledge is needed to coordinate and integrate sensory and perceptual receptors, which are responsible for thoughts, speech and actions of nurses, so that a wise, spiritualist, ethical and aesthetic (Symphonic Quadrilateral) nursing can be realized. The realization of this perspective in nurses (as therapists, researchers, teachers, administrators or nursing leaders) will cause them to always ask themselves whether their thoughts, speech and actions are wise, spiritual, ethical and aesthetic or not [ 2 , 3 ]. There is tacit knowledge to explain the success of a leader, which is derived from daily experience. This knowledge, which is usually understood and expressed by terms such as professional intuition, guides the action of nursing leaders. The aesthetic knowledge of nursing leaders is derived from their experiences and leads to aesthetic practice. This knowledge is also used to create emotional meanings and sensory experiences related to organizational life [ 1 ]. Aesthetics is a holistic and multidimensional view, which is related to the skills and competence of people in interacting with complex situations [ 4 ]. Aesthetic practices such as taking, listening, looking and touching skills as well as ability to deal with emotions and feelings, are among important sources of knowledge. Another factor that should be considered in regard to aesthetics is that we need direct experience to assess aesthetics [ 4 ]. In fact, aesthetics is a construction of reason and logic that often originates from feelings and perceptions [ 5 ]. Aesthetic is also the main factor that enables nurses to understand the uniqueness of an experience [ 6 ]. Nursing in itself is a creative and purposeful profession, and nurses need their entire mental-perceptive capacities, which is based on skills and competences, to convey feelings and concepts to others. So as a mental process, nursing requires interpretation, sensitivity, imagination and active participation. Thus, Florence Nightingale refers to nursing as an art, and many theorists emphasize on the aesthetic aspect of nursing [ 7 ]. The existence of management structures in organizational studies is taken for granted, this is while leadership is intertwined with various factors and requires careful study and exploration of the dimensions of beauty and sublimity in the thought, speech and action of leaders or managers [ 8 ]. Aesthetic leadership is a well-established theory of leadership that has increasingly received attention in leadership studies [ 9 ]. However, it has not yet been widely considered in nursing and its place in nursing management is unclear [ 10 ]. Mannix (2015) in regard to aesthetic leadership in clinical settings, suggests that by using the capacity of aesthetics, one can overcome some of the shortcomings of transformational and integrative leadership. Meanwhile, the acceptance of aesthetic leadership, as a suitable and relevant model in nursing, makes it possible to combine art and aesthetics in nursing leadership. It also provides the means to recognize an expert nursing leader from other clinical leaders [ 10 ]. Aesthetic leadership is one of the leadership theories that are related to the followers and their mental views of the leader’s characteristics in the leader-follower duality [ 1 ]. Hansen et al. (2007) believed that one of the important characteristics of aesthetic leadership is the way that the followers views leaders' leadership characteristics and examine them [ 8 ]. Aesthetic leadership, as a leadership style, is considered by sensory, physical and emotional awareness and a strong moral purpose around the values ​​of justice and fairness. Hence, the three characteristics of cognitive-aesthetic leadership include; 1) the quality of emotional, sensory and physical awareness, 2) an interest in cultivating bio-organizational aesthetic, and 3) promotion of moral goals [ 11 ]. The importance of leadership in solving the shortcomings of clinical setting in health care systems around the world has been found to be related to the need for effective leadership and influence. Professional nursing organizations have recognized this issue along with the global organizations, such as International Council of Nurses (2014) and International Sigma Theta Tau (2014), and have placed nursing leadership development at the forefront of their activities [ 12 ]. In 21st century, the transformational leadership model in nursing is reflected as the preferred leadership model in the professional development of nursing leadership research [ 13 ]. Considering the need for more effective clinical leadership and the dominance of transformational leadership in nursing, it is clear that the place of aesthetic leadership in clinical practice needs to be reframed. By using aesthetic leadership and aesthetic processes, some of the identified shortcomings of transformational leadership can be resolved [ 14 ]. The aesthetic-based leadership emphasizes on the validity of art and aesthetics in nursing [ 10 ]. Since leadership and aesthetics are both abstract, context-oriented and novel concepts, and also taking into account the complexity of nursing leadership in the bio-organizational context of health system, it seems that further investigation and analysis should be done on this subject. The objective manifestation of aesthetic leadership from the nursing managers and leaders’ viewpoint is an important issue that has not been widely addressed in nursing leadership studies. In general, examining the aesthetics in clinical leaders (especially, nursing leaders) and the characteristics of these leaders have received little attention from researchers. Studies of aesthetic leadership in nursing are also quite new, especially in Iran. Therefore, it is necessary to explain the position of aesthetic leadership in Iranian nursing leadership. It seems that after explaining the limits of aesthetics in leadership and management studies, aesthetics can provide valuable insights into the thoughts, speech and actions of nursing leaders. In fact, since the aesthetic approach has transformed organizational leadership and management, and had made the organization interesting and efficient, it is important to know the characteristics of an aesthetic leader, especially his/her thoughts, speech and actions. This study was conducted with the aim of explaining the position of aesthetics in nursing leadership in Iran. 2. Study method This is a qualitative study with conventional content analysis approach that aims to explain the position of aesthetics in Iranian nursing leadership in Tehran University of Medical Sciences. Sampling was done by purposeful and snowball sampling methods. The first sample was selected from Tehran Faculty of Nursing and Midwifery by the suggestion of veteran professors who were familiar with the topic of aesthetic leadership. Other samples were introduced by the eligible managers (snowball method). In this way, after the end of first interview, the interviewee, who had senior, middle or operational management experience in three teaching hospitals of Tehran University of Medical Sciences, introduced other managers/leaders for the interview. Before the interview, to ensure the correct selection of samples, a number of nurses and employees were asked about the manager's thoughts, speech and actions. In this way, the selection of samples was ensured by asking people who were under the management of managers who were famous for aestheticism. The research community included the leadership team and managers of three teaching hospitals of Tehran University of Medical Sciences, who were at senior, middle and operative management levels. Inclusion criteria included being a senior, middle or operational leader/manager who is currently working in leadership position while being known for aesthetics style leadership. In the meantime, people who wanted to be interviewed were also included in the study. A total of 28 people were interviewed, including hospital director of nursing (matron), midlevel nursing managers (supervisors), and nursing operational managers (head nurses) with lived experience of aesthetic nursing. A total of 28 interviews were conducted with 5 director nurses, 12 supervisors and 11 head nurses working at the teaching hospitals of Tehran University of Medical Sciences. Each participant was interviewed only once. In this study, in order to observe maximum variation in sampling, we interviewed both veteran aesthetic managers and also young aesthetic managers who were in their early years of management. We also interviewed both male and female managers. Considering the different conditions of hospital departments, we made an effort to select aesthetic managers from different departments of teaching hospitals of Tehran University of Medical Sciences. The interviewees were working in different departments with different conditions, such as intensive care units, emergency departments, and medical departments (both children and adult departments). Due to the novelty of aesthetics in nursing, despite reaching data saturation, more interviews (the main method of data collection) were conducted with the aesthetic leaders. The interviews were conducted in a semi-structured and face-to-face manner. The duration of each interview was approximately between 30 and 120 minutes, with an average of 75 minutes. All interviews were conducted in a quiet environment, usually the managers' office or another quiet place at the participants’ convenient time. The researcher started the interview with general questions and then directed the interview according to the participant’s statements. She also used probing questions to clarify any ambiguity. After obtaining demographic and professional information from the nursing managers, an interview guide was used to maintain the reliability of the data. The purpose of having an interview guide was to ensure the coherence and stability of study process. Interviews were recorded using a digital audio recorder and then were typed verbatim before being entered into MAXQDA-2020 software for analysis. In order to analyze the data, the text of each interview was transcribed and coded using the Griesheim & Landman’s approach of conventional content analysis. The criteria of acceptability, reliability, transferability, and confirmability were used to assess the validity and strength of the data, and to evaluate the research process. In order to ensure the acceptability of the data, data collection and analysis were done step by step under the guidance of experts in research team. To achieve reliability, prolongation of data collection (conducting interviews) was avoided as much as possible and the participants were interviewed according to the interview guide. To ensure the transferability of data, the principle of maximum variation was observed in sampling, and finally to ensure the confirmability of data, the study method and process were accurately recorded to enable others to repeat the study. To conduct this research, ethics approval was obtained from the joint organizational ethics committee of the Nursing/Midwifery and Rehabilitation Faculties of Tehran University of Medical Sciences (IR.TUMS.FNM.REC.1401.122). Before interviewing the participants, we obtained the necessary permission according to the approved process of each hospital and its research committee. All interviews were conducted after obtaining a written informed consent from the participants. 3. Findings A total of 28 interviews were conducted with the nursing managers of 5 general and 8 specialized hospitals. Table number one shows the demographic characteristics of the participants. Table 1: demographic characteristics of the participants Variable Head nurse Supervisor Matron Mean age (years) 48.3 48.5 49.4 Gender Female 9 11 5 Male 2 1 - Mean work experience (year) 23 21 25.8 Mean experience of management position (year/month) 9.9 13 19 Education bachelor 10 3 - master 1 8 3 PHD - 1 2 A total of 1482 codes were extracted from 28 interviews, which were classified in three main categories (aesthetic thought, aesthetic speech and aesthetic actions) and nine subcategories. 3-1. Aesthetic thought: It includes the beliefs and thoughts of an aesthetic leader. 3-1-1. The ethics-based aesthetic thought: The participants talked about having self-discipline, not feeling superior to others, believing in respect at work, striving to improve organizational ethics, trying to understand people, believing in benevolence for others, having a clear conscience, paying attention to human dignity, and being ethics-oriented, in their interview. There is some sort of thought with internalized moral values in leaders in such a way that they want maximum benevolence for most people. According to the participants, it is very important to consider the conscience and ability of a manager in putting him/herself in place of others in order to understand people and situations in management affairs. These are qualities that can facilitate other activities of the organization in an ethics-based manner: "As a supervisor or a head nurse, it's very important to me to go home, put my head on the pillow and fall sleep quickly, knowing that my conscience about the what I have done today in the hospital is clear." 3-1-2. The spiritual-based aesthetic thought : The participants also talked about loving the nursing, being at peace with own identity as a nurse, paying attention to the human values of nursing, giving importance to the self-fulfillment of personnel and happiness of others, giving importance to own peace and peace of others, giving importance to the spiritual aspect of nursing, paying attention to the sublime beauty, having positive view, believing in the world’s order and goodness of God, and being soft-hearted. Spirituality, in the mind of managers, is loving existence, which is manifested in the organizational life of a nursing leader, and his/her love of the profession and the stakeholders. A participant, based on his experiences, stated that: "First, you have to be a good nurse and like your work, patients and colleagues, then you can become a head nurse. If you dislike patients and don't want to look after them properly, what would be the point of becoming a head nurse. You will pass your bad mentality to other nurses. Well, these behaviors affect the collective unconscious.” 3-1-3. The intellectual-based aesthetic thought: The participants' experiences were reflecting issue, such as importance of having the knowledge of organizational communication, the importance of principles and rules of appearance, meritocracy, desire to have independent power in nursing management, combining science and art in nursing, having concern for creating standard conditions for nursing, having an integrated speech, actions and thoughts, creating emotional organizational commitment in nurses, having mental order, giving importance to correct performance, frequent ideation, alignment and empathy of management team for success, idealism, trying to create and preserve the society's mental image of nurses, having flexible thinking, paying attention to cultural differences, paying attention to the future, prioritizing the safety and health of patient, and believing in organizational order. One of the participants in this regard stated that: "The principle of a nursing manager's thinking can be summarized in a sentence that can be found in nursing books: Nursing and nursing management is an art and a science, which should be understood.” 2-3. Aesthetic speech: It refers to the verbal and non-verbal communication of aesthetic leaders in the position of management and leadership. 1-2-3. Ethics-based aesthetic speech The participants’ experiences were reflecting issue, such as preserving respect in speech, having courage in speech, being fair in speech, maintaining human dignity in speech, having honesty and truthfulness in speech, and respecting people's privacy in speech. According to the leaders, a speech is ethical when its content has human values. A participant in this regard said: "The most important thing to remember is that the person who is talking to you is a human being, so it is important to maintain his/her respect and dignity. It doesn't matter he is a worker or the head of a hospital." Another participant stated that: "I am a manager and, as a representative of a number of people, if I don't say certain things in the committees and meetings, I have betrayed my colleagues and profession." 2-2-3. The spiritual-based aesthetic speech: The participants talked about issue such as humor, paying attention to the meaning of words, showing empathy with words, and positivity in choosing words. According to the participants, spirituality in organizational management is related to the flow of positive emotions in management functions. By understanding this issue, aesthetic leaders can express spirituality and create positive feelings in the organization and its beneficiaries by using capabilities such as speaking skills. A participant in this regard stated: "Say two beautiful words to your nurses with a positive feeling, and see they will become completely fresh and their appearance will change. They will also go up to the patient with morals and a good feeling. I mean we can use the power of words to this extent." 3-2-3. The intellectual-based aesthetic speech: The participants talked about issue such as trust-building speech or trust in speech, paying attention to the principles and rules of non-verbal communication and body language, having the right tone, explaining properly, calling correctly, speech therapy, using beautiful words in speech, sincerity in speech, having a suitable communication technique in speaking with each person, observing order and consistency in speech, professional speech in the work environment, using words as a punishment and encouragement tool, and speaking in a calm voice. Leaders considered intellectual in speech to be the knowledge and skill of verbal communication with the organization's stakeholders. A participant in this regard stated that: "Especially, the new generation with whom you want to communicate, like to be talked to with their own literature, which means that they like us to use the same terms and slang when talking to them." By the way, if you talk to them in their own language, they will communicate with you better, they will listen to you better, they will count on you more as a manager, and they will trust you more." 3-3. Aesthetic role: The role of a manage is evident in planning, organizing, recruiting, directing, coordinating, reporting, budgeting, etc. It is mentioned in the manager’s job description. 1-3-3. The ethics-based aesthetic action: The participants talked about issues such as mutual understanding of colleagues, observing politeness and respect in actions, trying to preserve the rights of employees, moralism, ethical-judgment, using ethical punishment methods, appreciating and realizing the hard work of employees, observing justice, being patient, having forgiveness, communicating with benefactors for the good of hospital, and preserving benevolence in action. They believed in moral values in their thoughts and adherence to internalized values in their managerial actions. A participant talked about his experiences: "I have seen nursing managers who mistreat any staff who is doing a master’s degree, giving them harder shifts and doing anything to make them abandon their work or studies. if I was a matron, I would tell those nurses, I will help you as much as I can for your progress, on the condition that you would also help nursing." 2-3-3. The spiritual-based aesthetic action: Participant referred to issues, such as friendliness, creating a positive attitude in nursing, celebrating birthdays for staff and patients, supporting the material and spiritual rights of service recipients, taking care of people’s soul and spirit, loving patients, and creating satisfaction in employees. Spiritualism in the actions of leaders can be seen as the efforts of leaders to spread a positive feeling in the organization through general and specific managerial functions. Based on his experiences, a participant said: "My strictness is accompanied by love and support. I am a supervisor, I don't just say that you should do such and such. I like my staffs, and they know that I, as an elder, I support them in all fields. I feel that I should support my staffs, patients and even their families in every way." 3-3-3. The intellectual-based aesthetic action: The participants talked about issues such as creating motivation, empowerment, knowledge and right attitude in personnel, providing services in accordance with protocols and laws, providing extensive and scientific public relations, delegating authority, creating a positive organizational atmosphere, building trust in patients, controlling anger, culture building, persistence, organizational communication, artistic management of errors, succession process, collaborative management, giving importance to time and punctuality, prioritizing tasks, being a listener as manager, being responsible, going extra mile beyond job description, being practical, learning different skills for self-sufficiency at work, being interested in a branch of art, being sharp, paying attention to environmental events, being sensitive to establishing order in the environment, being accurate and paying attention to details. Aesthetic leaders in this study gave examples of their managerial functions and explained the characteristics of their actions in different areas. In addition to science, art, experience and skills of managers, the common ground of intellectuality in managerial functions can be seen in the creativity of these leaders. Among their comments, the leaders stated that the aestheticism of an action in the organization is related to organizational communication. In this regard, a participant stated that: "Inner beauty is also an outer beauty, and what is beautiful is the communication method. The communication between colleagues, between colleagues and patient as well as patient's companion, and even between colleagues and equipment, helps us to provide our services and reach our goal. I try my best to be good and make positive changes.” Discussion The purpose of this study was to explain the position of aesthetics in Iranian nursing leadership. The findings showed that spirituality, ethics and intellectuality are aspects of aesthetics in the organizational life of aesthetic leaders. Spirituality is one of the human virtues that gives meaning and purpose to human life. It is also a way of life and makes a connection between a person, himself, others and the whole universe. Concepts such as meaningfulness of life, purposefulness, hope, destiny, existentialism, transcendence, feeling of peace and tranquility, and connecting with others and the universe are hidden in the existing definitions of spirituality [15]. From this point of view, we can refer to spirituality-based aesthetics such as spirituality-based aesthetic thought, or peace and tranquility with oneself and others. Radmehr et al. (2015) explained the aesthetics in nursing care from the perspective of patients and nurses. They found that the aesthetics in nursing care includes mental description, spiritualism in care, and feeling of unity and empathy between nurse and patient [16]. Spiritualism has been mentioned as one of the aesthetic aspects of nursing care in management and leadership. Spiritualism has aesthetic characteristics and this aesthetics is related to noble affairs. In the spirituality-based aesthetic speech section, leaders referred to humor, paying attention to the sense and meaning of words, showing empathy through words or positivity in choosing words, and in the spirituality-based aesthetic thought section, leaders talked about the love of nursing, having peace with one's identity as a nurse, paying attention to the human values of nursing profession, giving importance to the self-fulfillment of personnel, giving importance to the happiness of people, giving importance to peace with oneself and others, paying attention to sublime beauty, positivity, believing in the world’s order, believing in the goodness of God, and being soft-hearted. Farasat et al., (2024) emphasized on the vital role of aesthetic leadership in increasing self-efficacy and self-fulfillment of employees. Aesthetic leaders can create an environment in which challenges are considered as opportunities, and also cultivate a flexible and highly efficient workforce [17]. From the perspective of aesthetic leaders, the source of beauty in spirituality is kindness and love for humans and existence. Alabbas et al. (2019) stated that an aesthetic leader strives to achieve the organization’s goals and participate in fateful decisions with a feeling of happiness, hope and optimism and a kind of positivity, and this leads to intimacy and mutual dependence between leaders and employees [18]. Positivism is one of the identified subctegories, which is related to the spirituality-based aesthetic thought from leaders’ perspective. It shows the attitude of leaders towards nursing and how they deal with the organizational bio-events. The aesthetic leaders love their organizational life. This originates from the nursing itself, which is half love and half logic. The integration of love and logic can objectify the aesthetic leaders’ view of an aesthetic nurse. Spiritual intelligence helps people to achieve positive attitude by providing purposefulness in them, which is very helpful in achieving a positive attitude in life [19]. Through spiritual intelligence, managers frame and reinterpret their experiences and deepen their knowledge [20]. The nurses’ aesthetics is what enables them to understand the uniqueness of an experience [10], and spiritualism and aesthetics of a leader play a vital role in the interpretation of bio-organizational experiences. By taking advantage of spirituality, a leader can understand the real value of life, and carry out his/her duties. Creating a positive attitude toward nursing is an example of spirituality-based aesthetics actions by aesthetic leaders. We present a definition of spiritual aesthetics from the perspective of aesthetic leaders. In this definition, spiritual aesthetics has several aspects such as spirituality in nursing leadership. Hence, spiritual-based aesthetics is a positive attitude and insight that is created by believing in an order that originates from divine intellectuality. In this definition, positive attitude refers to concepts such as love, peace, tranquility and kindness, and can be applied in thought, speech and actions. Although beauty has different meanings in different times and cultures, it has the same human roots. In the eyes of aesthetic leaders, beauty is associated with good will for the beneficiaries. In the current research, the connection between goodness and beauty can be seen in the leaders' references to benevolence in the categories of ethics-based aesthetic thoughts and actions. By comparing the findings of interviews with the definitions of aesthetics by philosophers, we can find common roots. In Kant's philosophy, beauty is a symbol of morality. Aesthetic leaders in this study believed in the ethical principles and values of nursing profession. For example, justice is a professional value and the expression of this internalized value can be seen in ethics-based aesthetic actions (which includes concepts such as observing justice) or ethics-based aesthetic speech (which includes fairness and justice in speech). With this point of view, in the world of these leaders, morality can be considered a symbol of sublime beauty. In Iran, nursing ethics refers to the nurses’ moral concepts [21]. By matching the findings of interviews with the nursing ethics in Iran, we can reach a common ground for aesthetics and ethics. For example, in regard to the moral value of respecting client/patient and preserving human dignity, we can refer to the manager's attention to human dignity in the category of ethics-based aesthetic thought or in the category of ethics-based aesthetic speech. In Schiller's view, beauty is the aesthetic education of an ethical person [22]. Gharib et al. (1402) in a study intended to design a model for the antecedents of nurses' professional ethics development, and showed that the leadership style is one of the key factors in the development of professional ethics in the organization. The selection of correct managers, revision of policies and detailed planning for the cultivation of ethical human resources can be the basis for the development of ethics in the organization [23]. The efforts of aesthetic-cognitive leaders for the aesthetic education of ethical people and spread of beauty in the organization can be combined by measures such as ethical judgment, the use of ethical punishment methods, and realization of employee’s efforts. Previous researches have argued that bioethics and aesthetics cannot be defined separately from each other. Aesthetics can be considered as a specific appearance or general beauty, like a brave behavior that has an inherently beautiful essence in all cultures [24]. For example, having courage in speech is one of the manifestations of ethics-based aesthetics, which leaders in this study also referred to in the category of ethics-based aesthetic speech. Moral intelligence is defined as the ability to understand right from wrong, having strong moral beliefs and acting on them, and behaving ethically [25]. Lenik and Keel talked about moral compass, which is a kind of trained automatic thinking. This moral compass connects moral thought and action. Moral action occurs when moral thinking works properly [26], and this connects ethical thought, ethical speech and ethical actions. Organizational ethics committees are the result of aesthetic thinking and actions of organization leaders with lofty goals. Nursing management and leadership team in these committees along with other interdisciplinary members of the hospital in response to the question: "How should I/we decide and act?", have a discussion to manifest the beauty of ethics in the organization. Ethics-based aesthetic nursing managers and leaders are the foundation and implementers of these committees' high missions [27]. Therefore, the governance of ethics in the organization can lead to the creation of an aesthetic organization. Good conscience of these leaders can also lead to their ethical speech and actions. Jodki et al. (1402) in a research investigated the meaning of conscience and examined its effect on the performance of nurses in critical care unit. Their findings led to the formation of categories such as understanding of conscience, and making infinite effort in care as a way to reach a clear conscience. The category of understanding conscience included three subcategories of conscience as an inherent capital and internal observer, dynamics of conscience, and conscience as a cornerstone of ethics. The category of making infinite effort in care as the way to a clear conscience also consisted of four subcategories; paying full attention to the patient, putting oneself in other's place, being responsible and working beyond the job description [28]. Beauty is the discoverer of truth that connects us to the world. Beauty also flourishes the truth [22, 29]. Therefore, the aesthetic leaders, by relying on "intellectual", strive to manifest the truth in their thoughts, speech and actions. Philosophy deals with reasonable issues, but it largely neglects tangible issues. Aesthetics as a part of philosophy shows the deficiency of philosophy in relation to the tangible issues [22]. Barnawi (2019) believes that a wise nurse is a nurse who has sufficient nursing knowledge (aesthetic, ethical, clinical and personal), controls his/her internal and external emotions, manages possible risks with critical thinking and prevents them, and also resolves moral conflicts slowly and decisively. Their results also showed that wise nursing has four major aspects, which include morality and spirituality, nursing management and leadership, clinical experiences and nursing education [30]. Based on the findings of present study, aesthetic leaders believed that nursing is an art, and the manifestation of this idea was seen in their management's artistic actions and speech. Although the emphasis on specific aspects of intellectual is different in cultures and time periods, perception of intellectual is similar in most people [31]. intellectual, knowledge and truth (as aspects of beauty) are related to each other and allow people to discover new concepts, paradigms and theories about different life experiences [32]. A wise leader is characterized by a combination of workplace knowledge and the capacity to predict results in a dynamic work environment. In this regard, intellectual astuteness, motivated action, ethical behavior and humility are all vital elements of wise leadership. For example, in relation to the leader's motivation, the efforts of aesthetic leaders to create knowledge and attitude in nurses can be referred to as intellectual -based aesthetic actions [31]. Bathla and Gahlot (2021) is a study referred to three main elements of the leader's aesthetic intelligence; 1) presence, 2) reliance, and 3) blend. Presence means that aesthetic leaders are aware of themselves and others, as well as their environment. Aesthetic leaders simultaneously pay attention to everything in the environment, including sights, sounds, smells, or even non-verbal communication. Thus, aesthetic leaders are aware of their intuitive feelings, emotions and thoughts, because they are acutely observing their organizational environment. Reliance is related to the leader's alignment with the topic, time, audience and intent. Blend refers to combining different visual, cognitive, motion, auditory and spatial aspects, and also creating ideas and actions. The five senses (hearing, sight, touch, smell, taste) as well as the sixth one (intuition) create one’s experience of a situation [1]. All three characteristics of aesthetic intelligence are consistent with the findings of interviews we conducted with the aesthetic leaders. The sensitivity of leaders' senses and their conscious presence in the organizational situations were expressed by leaders through notions such as paying attention to environmental events, being a careful listener, paying attention to non-verbal communication and body language, and considering details and order of the environment, Also, the alignment of thoughts, speech and actions of the leaders confirms their organizational reliance. Meritocracy is one of the intellectual -driven aesthetics, which was mentioned by the aesthetic leaders in this study. Previous studies have shown that followers are attracted to leasers due to the ability of leaders to fulfill their ideals to create a wonderful organizational life [33]. The findings of present study also showed the idealism of aesthetic leaders in the organization. Being a role model and practicality of leaders are among intellectual -based aesthetic actions that confirm the findings of previous studies. Wise leaders use moral compass to set boundaries for their behavior, keep their promises, and align their actions with their speech [34]. Aesthetic leaders in this study also referred to the alignment of thought, speech and actions as an expression of intellectual -based aesthetics, and also tried to build trust among the stakeholders. According to our findings, trust in speech is an example of intellectual -based aesthetic speech. Hassi and Storti (2023) proved that leaders with intellectual -based characteristics, by creating a positive organizational climate and supportive work environments, are more effective in retaining employees and increasing their organizational commitment. Aesthetic leaders in this study also had some concerns over nurses’ welfare and standards, and were in favor of creating a supportive work environment. The participants referred to the creation of organizational commitment for employees as a kind of aesthetics in the organization, so they were trying to create a positive organizational atmosphere. It can be argued that the common ground of aestheticism and intellectual, is tacit knowledge, strong senses and emotions, and intuition. Based on previous studies, intellectual is one of the qualities that leaders need. Aesthetic-oriented leaders with benevolence, which are the main components of intellectual, deal with the management of problems in the organization and its employees. As mentioned, the components of intellectual correspond to those of beauty from the perspective of aesthetic leaders in our study. Morality and spirituality are also important component of intellectual. Aesthetic leaders who have intellectual guide the issues they face and give meaning to them. They also use their intellectual to achieve excellence. The wise aesthetic leaders can achieve spirituality and realize their potential abilities gained through interaction with the world. intellectual enables these leaders to take advantage of any situation in life and move towards spiritual and moral excellence, which is the ultimate goal of human creation [35]. In this study, we formulated a following definition for intellectual -based aesthetics based on the interviews conducted with the aesthetic leaders and review of the available texts: “intellectual -based aesthetics is a kind of integrated and coherent thinking (thought) around a situation that causes aesthetic actions (speech and actions), guiding the situation and giving meaning to it”. Conclusion By examining the interviews of aesthetic leaders, it may be possible to reach a new definition of aesthetics in the organization and subsequently in the health care system: “Aesthetics is a pleasant phenomenon in the professional life of nurses. In this study, an attempt was made to explain the position of aesthetics in Iranian nursing leadership by presenting definitions of aesthetic in thought, speech, and actions pf nursing leaders. The findings of this study consolidate the findings of previous studies in terms of theoretical foundations for the development of aesthetic literature and aesthetic leadership. In terms of methodology, this study presents an aesthetic nursing leadership model in the health care system in order to create a therapeutic environment, which is dynamic, cheerful and creative. Since aesthetic structure may not always be observed directly in the organization, recognizing the aesthetic characteristics that exist in nursing leaders (thoughts, speech and actions), helps to create an aesthetic organization and protect existing aesthetic values. Declarations Acknowledgements: The study is derived from MS of nursing thesis, and researchers would like to express sincere appreciation to the Nursing Management and Leadership Team of Medical Sciences Hospitals who contributed to this project. Author contributions : NP collected the data and wrote the manuscript. MACH supervised the thesis and controlled the entire process, including editing the manuscript. ME and FHB provided consultation for the thesis and assisted with interpretation. MACH and NP analyzed the data. All authors read and approved the final manuscript. Funding: No funding was received for this work. Data availability: All data generated or analyzed during this study are included in this published article. Ethics approval and consent to participate We obtain approval from the Joint Committee of Organizational Ethics of Tehran University of Medical Sciences. (Code: IR.TUMS.FNM.REC.1401.122).Informed consent was obtained from the nursing managers and leaders to participate in the study. Consent for publication: Not applicable Competing interests: The authors declare no competing interests No patient or public contribution: Our manuscript is a descriptive qualitative article, in which the necessary data was obtained by interview, and at the beginning of interveiw, informed consent was obtained from the nursing leaders and managers to participate in the study. Participants were assured of the confidentiality of the information. This study is not an interventional study, so did not require any intervention on nurses or patients or anyone else. References Gahlot S, Bathla A. Aesthetic Leadership: A Review. FOCUS. 2021;23(4):39. Najafi F, Cheraghi M, Pashaeipour S, Ghane G, editors. Clarifying the concept of the four‐season symphony (I SEA) in nursing practice: A Wilson's approach to concept analysis. Nursing Forum; 2021: Wiley Online Library. Ghane G, Cheraghi MA, Pashaeypoor S, Najafi F, editors. Concept analysis of the Four‐Season‐Symphony of Intellectuality–Spirituality–Ethics–Esthetics (FSS: I SEA) in nursing research. Nursing Forum; 2021: Wiley Online Library. Harris AM. The creative turn: Toward a new aesthetic imaginary: Springer Science & Business; 2014. Powers BA, Knapp TR. Dictionary of nursing theory and research: Springer publishing company; 2010. Poursaadat N, Cheraghi MA, Hajibabaee F. Exploring of Ethical Aesthetics from the Opinion of Nursing Managers. -i -i , i.e., Quarterly Journal of Medical Ethics. 2023; 17(48): e24. Shahsavari H, Salsali M, Mohammadpour A. Nursing as an Art. Hayat. 2010;16(1). Hansen H, Ropo A, Sauer E. Aesthetic leadership. The Leadership Quarterly. 2007;18(6):544-60. English FW, Ehrich LC. El Cid: Can an Aesthetics Lens Save Transformational Leadership from Itself? Education Sciences. 2024;14(6):655. Mannix J, Wilkes L, Daly J. Aesthetic leadership: its place in the clinical nursing world. Issues in mental health nursing. 2015;36(5):357-61. Katz-Buonincontro J. How Might Aesthetic Knowing Relate to Leadership? A Review of the Literature. International Journal of Education & the Arts. 2011;12. Conger JA, Kanungo RN. Charismatic leadership in organizations: Sage Publications; 1998. Cummings GG, MacGregor T, Davey M, Lee H, Wong CA, Lo E, et al. Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review. International journal of nursing studies. 2010;47(3):363-85. Kuepers WM. “Trans‐+‐form” Leader‐and followership as an embodied, emotional and aesthetic practice for creative transformation in organisations. Leadership & Organization Development Journal. 2011;32(1):20-40. Seymour B. What do nursing students understand by spirituality and spiritual care. Scott J Healthcare Chaplain. 2009;12(2):38-46. Radmehr M, Ashktorab T, Abedsaeedi Z. Nursing Care Aesthetic in Iran: A Phenomenological Study. Nurs Midwifery Stud. 2015;4(2):e27639. Farasat M, Gull M, Hassan S. Unveiling the influence of Aesthetic Leadership: Enhancing Employee Self-Efficacy through Job-Capabilities Matching and the Pygmalion Effect. Remittances Review. 2024;9(1):3317-37. Alabbas SAA, Jawad MRB, Sarhan SHE. The Aesthetic Leadership and Its Role in Prompting the Creative Work Behaviour. Opción: Revista de Ciencias Humanas y Sociales. 2019(22):1057-87. Moghtader L, Akbari B, Minaei H. Comparison of life expectancy, spiritual intelligence and depression in women with breast cancer and healthy women in Rasht. Journal of Women and Family Studies. 2015;7(28):128-15. Shahbazi A, Rahgozar H. The Relationship Between the Relationship between Moral Intelligence with Organizational Commitment and Organizational Trust Among Employees of Islamic Azad University Marvdasht Branch. Journal of New Approaches in Educational Administration. 2017;8(30):209-34. Sanjari M, Zahedi F. Ethical codes of nursing and the practical necessity in Iran. 2008. Sauvanet P. Éléments d’esthétique: Ellipses; 2014. Gharib M, Ghashghaizadeh N, Omidian F, Gharib M. Designing a Model of the Antecedents of the Development of Nurses' Professional Ethics. Health. 2023;6(4):208-18. Little JM. Is there a real nexus between ethics and aesthetics? Journal of Bioethical Inquiry. 2010;7(1):91-102. Andam R, Roohparvar S. The survey of managers’ moral intelligence and effectiveness of voluntary sport organizations. Sport Management and Development. 2016;4(2):152-64. Soltani Z, Ebrahimi H, Hashemi J, Shahid NM. Development of a Communication Model of Moral Intelligence with Work Spirituality Mediated by Psychological Capital among the Armed Forces Staff. 2021. Hajibabaee F, Cheraghi MA, Joolaee S. Hospital Ethics Committee. Encyclopedia of Islamic Medical Ethics. 2023;1(1):1-13. Jodaki K, Esmaeili M, Cheraghi MA, Mazaheri M. Striving to keep a Clear Conscience by going above and beyond: the Experiences of Intensive Care Unit Nurses. Critical Care Nursing Quarterly. 2023;46(2):192-202. Kul-Want C. Introducing Kant: A Graphic Guide: Icon Books Ltd; 2015. Barnawi NA. Concept Analysis of Nursing Wisdom. Biomedical Journal of Scientific & Technical Research. 2019;23(1):17179-88. Hassi A, Storti G. Wise leadership: construction and validation of a scale. Modern Management Review. 2023;28(1):47-69. Elhattab NEMM. Does wisdom leadership drive employee advocacy and retention in tavel agencies? Journal of the Faculty of Tourism and Hotels-University of Sadat City. 2024;8(1/2). Ogunyemi O, Ogunyemi K. Authentic leadership: leading with purpose, meaning and core values. New Horizons in Positive Leadership and Change: A Practical Guide for Workplace Transformation. 2020:369-80. Verhezen P. A corporate governance perspective on organisational integrity. Research Handbook on Organisational Integrity: Edward Elgar Publishing; 2024. p. 280-300. Sadat Hoseini AS, Mohammadi M. The concept of intellectual nursing: literature review. Islamic Studies in Health. 2021;5(1):47-58. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5296193","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":371368027,"identity":"f55c278c-4984-456c-89a9-d5f3f3a4baf4","order_by":0,"name":"newsha poursaadat","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"newsha","middleName":"","lastName":"poursaadat","suffix":""},{"id":371368029,"identity":"626a3016-5e0f-4d52-ac91-cc801ff55b56","order_by":1,"name":"mohammad ali cheraghi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIiWNgGAWjYDACCTB5gIeBnbHxQYKBhBwDAw+xWpgZmw0+VNgYE62FgYGZgU1yxpm0xAZCWvhnNx/78OPXHRn+ZuYGad62w+kbjp89+OADg52cbgMOS+4cS57Z2/eMR+IwY4MxUEvuhjN5yYYzGJKNzQ5g12IgkWPMwNtzmIcBqCUZrOVAjpk0D8OBxG04teR/ZvwL1CIP1HIY5DCD828IaclhZub5cZjH4DBjYyPQ+wkGNwjYInEjzZhZtuEwj+FhxmYGYCAbzrzxxthwhgFuv/DPSH7M+ObPYXu54+3PfwCjUp7vfI7hgw8VdnK4tIABYxsSRwGs0gCPcjD4g8SWbyCkehSMglEwCkYaAADdQmSLVGmMUAAAAABJRU5ErkJggg==","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"mohammad","middleName":"ali","lastName":"cheraghi","suffix":""},{"id":371368033,"identity":"0d9723b8-718c-4ac8-96fb-8f189d13e015","order_by":2,"name":"Maryam Esmaeili","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Esmaeili","suffix":""},{"id":371368035,"identity":"9f21391c-f253-46c8-b49e-5848b66bb63b","order_by":3,"name":"fatemeh hajibabaee","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"fatemeh","middleName":"","lastName":"hajibabaee","suffix":""}],"badges":[],"createdAt":"2024-10-19 21:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5296193/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5296193/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68766984,"identity":"0f4c012f-233c-4d95-a715-31bebd88de0a","added_by":"auto","created_at":"2024-11-11 20:53:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":485309,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5296193/v1/c6382c9b-e3b1-40b3-bd51-e73c702a99e8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Explaining the position of aesthetics in Iran’s nursing leadership","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe Greek word \u0026ldquo;aesthetic\u0026rdquo; refers to any sensory experience, regardless of being sensory, perceptual or artistic. Aesthetics drives from experience-based feelings and perceptions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Implicit knowledge is needed to coordinate and integrate sensory and perceptual receptors, which are responsible for thoughts, speech and actions of nurses, so that a wise, spiritualist, ethical and aesthetic (Symphonic Quadrilateral) nursing can be realized. The realization of this perspective in nurses (as therapists, researchers, teachers, administrators or nursing leaders) will cause them to always ask themselves whether their thoughts, speech and actions are wise, spiritual, ethical and aesthetic or not [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. There is tacit knowledge to explain the success of a leader, which is derived from daily experience. This knowledge, which is usually understood and expressed by terms such as professional intuition, guides the action of nursing leaders. The aesthetic knowledge of nursing leaders is derived from their experiences and leads to aesthetic practice. This knowledge is also used to create emotional meanings and sensory experiences related to organizational life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Aesthetics is a holistic and multidimensional view, which is related to the skills and competence of people in interacting with complex situations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Aesthetic practices such as taking, listening, looking and touching skills as well as ability to deal with emotions and feelings, are among important sources of knowledge. Another factor that should be considered in regard to aesthetics is that we need direct experience to assess aesthetics [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In fact, aesthetics is a construction of reason and logic that often originates from feelings and perceptions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Aesthetic is also the main factor that enables nurses to understand the uniqueness of an experience [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Nursing in itself is a creative and purposeful profession, and nurses need their entire mental-perceptive capacities, which is based on skills and competences, to convey feelings and concepts to others. So as a mental process, nursing requires interpretation, sensitivity, imagination and active participation. Thus, Florence Nightingale refers to nursing as an art, and many theorists emphasize on the aesthetic aspect of nursing [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe existence of management structures in organizational studies is taken for granted, this is while leadership is intertwined with various factors and requires careful study and exploration of the dimensions of beauty and sublimity in the thought, speech and action of leaders or managers [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Aesthetic leadership is a well-established theory of leadership that has increasingly received attention in leadership studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, it has not yet been widely considered in nursing and its place in nursing management is unclear [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Mannix (2015) in regard to aesthetic leadership in clinical settings, suggests that by using the capacity of aesthetics, one can overcome some of the shortcomings of transformational and integrative leadership. Meanwhile, the acceptance of aesthetic leadership, as a suitable and relevant model in nursing, makes it possible to combine art and aesthetics in nursing leadership. It also provides the means to recognize an expert nursing leader from other clinical leaders [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Aesthetic leadership is one of the leadership theories that are related to the followers and their mental views of the leader\u0026rsquo;s characteristics in the leader-follower duality [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Hansen et al. (2007) believed that one of the important characteristics of aesthetic leadership is the way that the followers views leaders' leadership characteristics and examine them [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Aesthetic leadership, as a leadership style, is considered by sensory, physical and emotional awareness and a strong moral purpose around the values ​​of justice and fairness. Hence, the three characteristics of cognitive-aesthetic leadership include; 1) the quality of emotional, sensory and physical awareness, 2) an interest in cultivating bio-organizational aesthetic, and 3) promotion of moral goals [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The importance of leadership in solving the shortcomings of clinical setting in health care systems around the world has been found to be related to the need for effective leadership and influence. Professional nursing organizations have recognized this issue along with the global organizations, such as International Council of Nurses (2014) and International Sigma Theta Tau (2014), and have placed nursing leadership development at the forefront of their activities [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In 21st century, the transformational leadership model in nursing is reflected as the preferred leadership model in the professional development of nursing leadership research [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Considering the need for more effective clinical leadership and the dominance of transformational leadership in nursing, it is clear that the place of aesthetic leadership in clinical practice needs to be reframed. By using aesthetic leadership and aesthetic processes, some of the identified shortcomings of transformational leadership can be resolved [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The aesthetic-based leadership emphasizes on the validity of art and aesthetics in nursing [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSince leadership and aesthetics are both abstract, context-oriented and novel concepts, and also taking into account the complexity of nursing leadership in the bio-organizational context of health system, it seems that further investigation and analysis should be done on this subject. The objective manifestation of aesthetic leadership from the nursing managers and leaders\u0026rsquo; viewpoint is an important issue that has not been widely addressed in nursing leadership studies. In general, examining the aesthetics in clinical leaders (especially, nursing leaders) and the characteristics of these leaders have received little attention from researchers. Studies of aesthetic leadership in nursing are also quite new, especially in Iran. Therefore, it is necessary to explain the position of aesthetic leadership in Iranian nursing leadership. It seems that after explaining the limits of aesthetics in leadership and management studies, aesthetics can provide valuable insights into the thoughts, speech and actions of nursing leaders. In fact, since the aesthetic approach has transformed organizational leadership and management, and had made the organization interesting and efficient, it is important to know the characteristics of an aesthetic leader, especially his/her thoughts, speech and actions. This study was conducted with the aim of explaining the position of aesthetics in nursing leadership in Iran.\u003c/p\u003e"},{"header":"2. Study method","content":"\u003cp\u003eThis is a qualitative study with conventional content analysis approach that aims to explain the position of aesthetics in Iranian nursing leadership in Tehran University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003eSampling was done by purposeful and snowball sampling methods. The first sample was selected from Tehran Faculty of Nursing and Midwifery by the suggestion of veteran professors who were familiar with the topic of aesthetic leadership. Other samples were introduced by the eligible managers (snowball method). In this way, after the end of first interview, the interviewee, who had senior, middle or operational management experience in three teaching hospitals of Tehran University of Medical Sciences, introduced other managers/leaders for the interview. Before the interview, to ensure the correct selection of samples, a number of nurses and employees were asked about the manager's thoughts, speech and actions. In this way, the selection of samples was ensured by asking people who were under the management of managers who were famous for aestheticism.\u003c/p\u003e\n\u003cp\u003eThe research community included the leadership team and managers of three teaching hospitals of Tehran University of Medical Sciences, who were at senior, middle and operative management levels. Inclusion criteria included being a senior, middle or operational leader/manager who is currently working in leadership position while being known for aesthetics style leadership. In the meantime, people who wanted to be interviewed were also included in the study. A total of 28 people were interviewed, including hospital director of nursing (matron), midlevel nursing managers (supervisors), and nursing operational managers (head nurses) with lived experience of aesthetic nursing.\u003c/p\u003e\n\u003cp\u003eA total of 28 interviews were conducted with 5 director nurses, 12 supervisors and 11 head nurses working at the teaching hospitals of Tehran University of Medical Sciences. Each participant was interviewed only once. In this study, in order to observe maximum variation in sampling, we interviewed both veteran aesthetic managers and also young aesthetic managers who were in their early years of management. We also interviewed both male and female managers. Considering the different conditions of hospital departments, we made an effort to select aesthetic managers from different departments of teaching hospitals of Tehran University of Medical Sciences. The interviewees were working in different departments with different conditions, such as intensive care units, emergency departments, and medical departments (both children and adult departments). Due to the novelty of aesthetics in nursing, despite reaching data saturation, more interviews (the main method of data collection) were conducted with the aesthetic leaders. The interviews were conducted in a semi-structured and face-to-face manner. The duration of each interview was approximately between 30 and 120 minutes, with an average of 75 minutes. All interviews were conducted in a quiet environment, usually the managers' office or another quiet place at the participants’ convenient time.\u003c/p\u003e\n\u003cp\u003eThe researcher started the interview with general questions and then directed the interview according to the participant’s statements. She also used probing questions to clarify any ambiguity. After obtaining demographic and professional information from the nursing managers, an interview guide was used to maintain the reliability of the data. The purpose of having an interview guide was to ensure the coherence and stability of study process. Interviews were recorded using a digital audio recorder and then were typed verbatim before being entered into MAXQDA-2020 software for analysis. In order to analyze the data, the text of each interview was transcribed and coded using the Griesheim \u0026amp; Landman’s approach of conventional content analysis. The criteria of acceptability, reliability, transferability, and confirmability were used to assess the validity and strength of the data, and to evaluate the research process. In order to ensure the acceptability of the data, data collection and analysis were done step by step under the guidance of experts in research team. To achieve reliability, prolongation of data collection (conducting interviews) was avoided as much as possible and the participants were interviewed according to the interview guide. To ensure the transferability of data, the principle of maximum variation was observed in sampling, and finally to ensure the confirmability of data, the study method and process were accurately recorded to enable others to repeat the study.\u003c/p\u003e\n\u003cp\u003eTo conduct this research, ethics approval was obtained from the joint organizational ethics committee of the Nursing/Midwifery and Rehabilitation Faculties of Tehran University of Medical Sciences (IR.TUMS.FNM.REC.1401.122). Before interviewing the participants, we obtained the necessary permission according to the approved process of each hospital and its research committee. All interviews were conducted after obtaining a written informed consent from the participants.\u003c/p\u003e"},{"header":"3. Findings","content":"\u003cp\u003eA total of 28 interviews were conducted with the nursing managers of 5 general and 8 specialized hospitals. Table number one shows the demographic characteristics of the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: demographic characteristics of the participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHead nurse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupervisor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMatron\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eMean age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e48.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e48.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e49.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eMean work experience (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eMean experience of management position (year/month)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003ebachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003emaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003ePHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA total of 1482 codes were extracted from 28 interviews, which were classified in three main categories (aesthetic thought, aesthetic speech and aesthetic actions) and nine subcategories.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-1. Aesthetic thought:\u003c/strong\u003e It includes the beliefs and thoughts of an aesthetic leader.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-1-1. The ethics-based aesthetic thought:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants talked about having self-discipline, not feeling superior to others, believing in respect at work, striving to improve organizational ethics, trying to understand people, believing in benevolence for others, having a clear conscience, paying attention to human dignity, and being ethics-oriented, in their interview. There is some sort of thought with internalized moral values in leaders in such a way that they want maximum benevolence for most people. According to the participants, it is very important to consider the conscience and ability of a manager in putting him/herself in place of others in order to understand people and situations in management affairs. These are qualities that can facilitate other activities of the organization in an ethics-based manner:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;As a supervisor or a head nurse, it\u0026apos;s very important to me to go home, put my head on the pillow and fall sleep quickly, knowing that my conscience about the what I have done today in the hospital is clear.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-1-2. The spiritual-based aesthetic thought\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe participants also talked about loving the nursing, being at peace with own identity as a nurse, paying attention to the human values of nursing, giving importance to the self-fulfillment of personnel and happiness of others, giving importance to own peace and peace of others, giving importance to the spiritual aspect of nursing, paying attention to the sublime beauty, having positive view, believing in the world\u0026rsquo;s order and goodness of God, and being soft-hearted. Spirituality, in the mind of managers, is loving existence, which is manifested in the organizational life of a nursing leader, and his/her love of the profession and the stakeholders.\u003c/p\u003e\n\u003cp\u003eA participant, based on his experiences, stated that: \u003cem\u003e\u0026quot;First, you have to be a good nurse and like your work, patients and colleagues, then you can become a head nurse. If you dislike patients and don\u0026apos;t want to look after them properly, what would be the point of becoming a head nurse. You will pass your bad mentality to other nurses. Well, these behaviors affect the collective unconscious.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-1-3. The intellectual-based aesthetic thought:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants\u0026apos; experiences were reflecting issue, such as importance of having the knowledge of organizational communication, the importance of principles and rules of appearance, meritocracy, desire to have independent power in nursing management, combining science and art in nursing, having concern for creating standard conditions for nursing, having an integrated speech, actions and thoughts, creating emotional organizational commitment in nurses, having mental order, giving importance to correct performance, frequent ideation, alignment and empathy of management team for success, idealism, trying to create and preserve the society\u0026apos;s mental image of nurses, having flexible thinking, paying attention to cultural differences, paying attention to the future, prioritizing the safety and health of patient, and believing in organizational order. One of the participants in this regard stated that:\u003cem\u003e\u0026nbsp;\u0026quot;The principle of a nursing manager\u0026apos;s thinking can be summarized in a sentence that can be found in nursing books: Nursing and nursing management is an art and a science, which should be understood.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2-3. Aesthetic speech:\u003c/strong\u003e It refers to the verbal and non-verbal communication of aesthetic leaders in the position of management and leadership.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1-2-3. Ethics-based aesthetic speech\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The participants\u0026rsquo; experiences were reflecting issue, such as preserving respect in speech, having courage in speech, being fair in speech, maintaining human dignity in speech, having honesty and truthfulness in speech, and respecting people\u0026apos;s privacy in speech. According to the leaders, a speech is ethical when its content has human values. A participant in this regard said: \u003cem\u003e\u0026quot;The most important thing to remember is that the person who is talking to you is a human being, so it is important to maintain his/her respect and dignity. It doesn\u0026apos;t matter he is a worker or the head of a hospital.\u0026quot;\u003c/em\u003e\u0026nbsp; Another participant stated that: \u003cem\u003e\u0026quot;I am a manager and, as a representative of a number of people, if I don\u0026apos;t say certain things in the committees and meetings, I have betrayed my colleagues and profession.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2-2-3. The spiritual-based aesthetic speech:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants talked about issue such as humor, paying attention to the meaning of words, showing empathy with words, and positivity in choosing words. According to the participants, spirituality in organizational management is related to the flow of positive emotions in management functions. By understanding this issue, aesthetic leaders can express spirituality and create positive feelings in the organization and its beneficiaries by using capabilities such as speaking skills. A participant in this regard stated: \u003cem\u003e\u0026quot;Say two beautiful words to your nurses with a positive feeling, and see they will become completely fresh and their appearance will change. They will also go up to the patient with morals and a good feeling. I mean we can use the power of words to this extent.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-2-3. The intellectual-based aesthetic speech:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants talked about issue such as trust-building speech or trust in speech, paying attention to the principles and rules of non-verbal communication and body language, having the right tone, explaining properly, calling correctly, speech therapy, using beautiful words in speech, sincerity in speech, having a suitable communication technique in speaking with each person, observing order and consistency in speech, professional speech in the work environment, using words as a punishment and encouragement tool, and speaking in a calm voice. Leaders considered intellectual in speech to be the knowledge and skill of verbal communication with the organization\u0026apos;s stakeholders. A participant in this regard stated that: \u003cem\u003e\u0026quot;Especially, the new generation with whom you want to communicate, like to be talked to with their own literature, which means that they like us to use the same terms and slang when talking to them.\u0026quot; By the way, if you talk to them in their own language, they will communicate with you better, they will listen to you better, they will count on you more as a manager, and they will trust you more.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-3. Aesthetic role:\u003c/strong\u003e The role of a manage is evident in planning, organizing, recruiting, directing, coordinating, reporting, budgeting, etc. It is mentioned in the manager\u0026rsquo;s job description.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1-3-3. The ethics-based aesthetic action:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants talked about issues such as mutual understanding of colleagues, observing politeness and respect in actions, trying to preserve the rights of employees, moralism, ethical-judgment, using ethical punishment methods, appreciating and realizing the hard work of employees, observing justice, being patient, having forgiveness, communicating with benefactors for the good of hospital, and preserving benevolence in action. They believed in moral values in their thoughts and adherence to internalized values in their managerial actions. A participant talked about his experiences: \u003cem\u003e\u0026quot;I have seen nursing managers who mistreat any staff who is doing a master\u0026rsquo;s degree, giving them harder shifts and doing anything to make them abandon their work or studies. if I was a matron, I would tell those nurses, I will help you as much as I can for your progress, on the condition that you would also help nursing.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2-3-3. The spiritual-based aesthetic action:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Participant referred to issues, such as friendliness, creating a positive attitude in nursing, celebrating birthdays for staff and patients, supporting the material and spiritual rights of service recipients, taking care of people\u0026rsquo;s soul and spirit, loving patients, and creating satisfaction in employees. Spiritualism in the actions of leaders can be seen as the efforts of leaders to spread a positive feeling in the organization through general and specific managerial functions. Based on his experiences, a participant said: \u003cem\u003e\u0026quot;My strictness is accompanied by love and support. I am a supervisor, I don\u0026apos;t just say that you should do such and such. I like my staffs, and they know that I, as an elder, I support them in all fields. I feel that I should support my staffs, patients and even their families in every way.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-3-3. The intellectual-based aesthetic action:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants talked about issues such as creating motivation, empowerment, knowledge and right attitude in personnel, providing services in accordance with protocols and laws, providing extensive and scientific public relations, delegating authority, creating a positive organizational atmosphere, building trust in patients, controlling anger, culture building, persistence, organizational communication, artistic management of errors, succession process, collaborative management, giving importance to time and punctuality, prioritizing tasks, being a listener as manager, being responsible, going extra mile beyond job description, being practical, learning different skills for self-sufficiency at work, being interested in a branch of art, being sharp, paying attention to environmental events, being sensitive to establishing order in the environment, being accurate and paying attention to details.\u003c/p\u003e\n\u003cp\u003eAesthetic leaders in this study gave examples of their managerial functions and explained the characteristics of their actions in different areas. In addition to science, art, experience and skills of managers, the common ground of intellectuality in managerial functions can be seen in the creativity of these leaders. Among their comments, the leaders stated that the aestheticism of an action in the organization is related to organizational communication. In this regard, a participant stated that: \u003cem\u003e\u0026quot;Inner beauty is also an outer beauty, and what is beautiful is the communication method. The communication between colleagues, between colleagues and patient as well as patient\u0026apos;s companion, and even between colleagues and equipment, helps us to provide our services and reach our goal. I try my best to be good and make positive changes.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this study was to explain the position of aesthetics in Iranian nursing leadership. The findings showed that spirituality, ethics and intellectuality are aspects of aesthetics in the organizational life of aesthetic leaders.\u003c/p\u003e\n\u003cp\u003eSpirituality is one of the human virtues that gives meaning and purpose to human life. It is also a way of life and makes a connection between a person, himself, others and the whole universe. Concepts such as meaningfulness of life, purposefulness, hope, destiny, existentialism, transcendence, feeling of peace and tranquility, and connecting with others and the universe are hidden in the existing definitions of spirituality [15]. From this point of view, we can refer to spirituality-based aesthetics such as spirituality-based aesthetic thought, or peace and tranquility with oneself and others.\u003c/p\u003e\n\u003cp\u003eRadmehr et al. (2015) explained the aesthetics in nursing care from the perspective of patients and nurses. They found that the aesthetics in nursing care includes mental description, spiritualism in care, and feeling of unity and empathy between nurse and patient [16]. Spiritualism has been mentioned as one of the aesthetic aspects of nursing care in management and leadership. Spiritualism has aesthetic characteristics and this aesthetics is related to noble affairs. In the spirituality-based aesthetic speech section, leaders referred to humor, paying attention to the sense and meaning of words, showing empathy through words or positivity in choosing words, and in the spirituality-based aesthetic thought section, leaders talked about the love of nursing, having peace with one\u0026apos;s identity as a nurse, paying attention to the human values of nursing profession, giving importance to the self-fulfillment of personnel, giving importance to the happiness of people, giving importance to peace with oneself and others, paying attention to sublime beauty, positivity, believing in the world\u0026rsquo;s order, believing in the goodness of God, and being soft-hearted. Farasat et al., (2024) emphasized on the vital role of aesthetic leadership in increasing self-efficacy and self-fulfillment of employees. Aesthetic leaders can create an environment in which challenges are considered as opportunities, and also cultivate a flexible and highly efficient workforce [17]. From the perspective of aesthetic leaders, the source of beauty in spirituality is kindness and love for humans and existence. Alabbas et al. (2019) stated that an aesthetic leader strives to achieve the organization\u0026rsquo;s goals and participate in fateful decisions with a feeling of happiness, hope and optimism and a kind of positivity, and this leads to intimacy and mutual dependence between leaders and employees [18]. Positivism is one of the identified subctegories, which is related to the spirituality-based aesthetic thought from leaders\u0026rsquo; perspective. It shows the attitude of leaders towards nursing and how they deal with the organizational bio-events. The aesthetic leaders love their organizational life. This originates from the nursing itself, which is half love and half logic. The integration of love and logic can objectify the aesthetic leaders\u0026rsquo; view of an aesthetic nurse. Spiritual intelligence helps people to achieve positive attitude by providing purposefulness in them, which is very helpful in achieving a positive attitude in life [19]. Through spiritual intelligence, managers frame and reinterpret their experiences and deepen their knowledge [20]. The nurses\u0026rsquo; aesthetics is what enables them to understand the uniqueness of an experience [10], and spiritualism and aesthetics of a leader play a vital role in the interpretation of bio-organizational experiences. By taking advantage of spirituality, a leader can understand the real value of life, and carry out his/her duties. Creating a positive attitude toward nursing is an example of spirituality-based aesthetics actions by aesthetic leaders.\u003c/p\u003e\n\u003cp\u003eWe present a definition of spiritual aesthetics from the perspective of aesthetic leaders. In this definition, spiritual aesthetics has several aspects such as spirituality in nursing leadership. Hence, spiritual-based aesthetics is a positive attitude and insight that is created by believing in an order that originates from divine intellectuality. In this definition, positive attitude refers to concepts such as love, peace, tranquility and kindness, and can be applied in thought, speech and actions.\u003c/p\u003e\n\u003cp\u003eAlthough beauty has different meanings in different times and cultures, it has the same human roots. In the eyes of aesthetic leaders, beauty is associated with good will for the beneficiaries. In the current research, the connection between goodness and beauty can be seen in the leaders\u0026apos; references to benevolence in the categories of ethics-based aesthetic thoughts and actions. By comparing the findings of interviews with the definitions of aesthetics by philosophers, we can find common roots. In Kant\u0026apos;s philosophy, beauty is a symbol of morality. Aesthetic leaders in this study believed in the ethical principles and values of nursing profession. For example, justice is a professional value and the expression of this internalized value can be seen in ethics-based aesthetic actions (which includes concepts such as observing justice) or ethics-based aesthetic speech (which includes fairness and justice in speech). With this point of view, in the world of these leaders, morality can be considered a symbol of sublime beauty. In Iran, nursing ethics refers to the nurses\u0026rsquo; moral concepts [21]. By matching the findings of interviews with the nursing ethics in Iran, we can reach a common ground for aesthetics and ethics. For example, in regard to the moral value of respecting client/patient and preserving human dignity, we can refer to the manager\u0026apos;s attention to human dignity in the category of ethics-based aesthetic thought or in the category of ethics-based aesthetic speech. In Schiller\u0026apos;s view, beauty is the aesthetic education of an ethical person [22]. Gharib et al. (1402) in a study intended to design a model for the antecedents of nurses\u0026apos; professional ethics development, and showed that the leadership style is one of the key factors in the development of professional ethics in the organization. The selection of correct managers, revision of policies and detailed planning for the cultivation of ethical human resources can be the basis for the development of ethics in the organization [23]. The efforts of aesthetic-cognitive leaders for the aesthetic education of ethical people and spread of beauty in the organization can be combined by measures such as ethical judgment, the use of ethical punishment methods, and realization of employee\u0026rsquo;s efforts. Previous researches have argued that bioethics and aesthetics cannot be defined separately from each other. Aesthetics can be considered as a specific appearance or general beauty, like a brave behavior that has an inherently beautiful essence in all cultures [24]. For example, having courage in speech is one of the manifestations of ethics-based aesthetics, which leaders in this study also referred to in the category of ethics-based aesthetic speech. Moral intelligence is defined as the ability to understand right from wrong, having strong moral beliefs and acting on them, and behaving ethically [25]. Lenik and Keel talked about moral compass, which is a kind of trained automatic thinking. This moral compass connects moral thought and action. Moral action occurs when moral thinking works properly [26], and this connects ethical thought, ethical speech and ethical actions. Organizational ethics committees are the result of aesthetic thinking and actions of organization leaders with lofty goals. Nursing management and leadership team in these committees along with other interdisciplinary members of the hospital in response to the question: \u0026quot;How should I/we decide and act?\u0026quot;, have a discussion to manifest the beauty of ethics in the organization. Ethics-based aesthetic nursing managers and leaders are the foundation and implementers of these committees\u0026apos; high missions [27]. Therefore, the governance of ethics in the organization can lead to the creation of an aesthetic organization. Good conscience of these leaders can also lead to their ethical speech and actions. Jodki et al. (1402) in a research investigated the meaning of conscience and examined its effect on the performance of nurses in critical care unit. Their findings led to the formation of categories such as understanding of conscience, and making infinite effort in care as a way to reach a clear conscience. The category of understanding conscience included three subcategories of conscience as an inherent capital and internal observer, dynamics of conscience, and conscience as a cornerstone of ethics. The category of making infinite effort in care as the way to a clear conscience also consisted of four subcategories; paying full attention to the patient, putting oneself in other\u0026apos;s place, being responsible and working beyond the job description [28].\u003c/p\u003e\n\u003cp\u003eBeauty is the discoverer of truth that connects us to the world. Beauty\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ealso flourishes the truth [22, 29]. Therefore, the aesthetic leaders, by relying on \u0026quot;intellectual\u0026quot;, strive to manifest the truth in their thoughts, speech and actions. Philosophy deals with reasonable issues, but it largely neglects tangible issues. Aesthetics as a part of philosophy shows the deficiency of philosophy in relation to the tangible issues [22]. Barnawi (2019) believes that a wise nurse is a nurse who has sufficient nursing knowledge (aesthetic, ethical, clinical and personal), controls his/her internal and external emotions, manages possible risks with critical thinking and prevents them, and also resolves moral conflicts slowly and decisively. Their results also showed that wise nursing has four major aspects, which include morality and spirituality, nursing management and leadership, clinical experiences and nursing education [30]. Based on the findings of present study, aesthetic leaders believed that nursing is an art, and the manifestation of this idea was seen in their management\u0026apos;s artistic actions and speech. Although the emphasis on specific aspects of intellectual is different in cultures and time periods, perception of intellectual is similar in most people [31].\u003c/p\u003e\n\u003cp\u003eintellectual, knowledge and truth (as aspects of beauty) are related to each other and allow people to discover new concepts, paradigms and theories about different life experiences [32]. A wise leader is characterized by a combination of workplace knowledge and the capacity to predict results in a dynamic work environment. In this regard, intellectual astuteness, motivated action, ethical behavior and humility are all vital elements of wise leadership. For example, in relation to the leader\u0026apos;s motivation, the efforts of aesthetic leaders to create knowledge and attitude in nurses can be referred to as intellectual -based aesthetic actions [31]. Bathla and Gahlot (2021) is a study referred to three main elements of the leader\u0026apos;s aesthetic intelligence; 1) presence, 2) reliance, and 3) blend. Presence means that aesthetic leaders are aware of themselves and others, as well as their environment. Aesthetic leaders simultaneously pay attention to everything in the environment, including sights, sounds, smells, or even non-verbal communication. Thus, aesthetic leaders are aware of their intuitive feelings, emotions and thoughts, because they are acutely observing their organizational environment. Reliance is related to the leader\u0026apos;s alignment with the topic, time, audience and intent. Blend refers to combining different visual, cognitive, motion, auditory and spatial aspects, and also creating ideas and actions. The five senses (hearing, sight, touch, smell, taste) as well as the sixth one (intuition) create one\u0026rsquo;s experience of a situation [1]. All three characteristics of aesthetic intelligence are consistent with the findings of interviews we conducted with the aesthetic leaders. The sensitivity of leaders\u0026apos; senses and their conscious presence in the organizational situations were expressed by leaders through notions such as paying attention to environmental events, being a careful listener, paying attention to non-verbal communication and body language, and considering details and order of the environment, Also, the alignment of thoughts, speech and actions of the leaders confirms their organizational reliance. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMeritocracy is one of the intellectual -driven aesthetics, which was mentioned by the aesthetic leaders in this study. Previous studies have shown that followers are attracted to leasers due to the ability of leaders to fulfill their ideals to create a wonderful organizational life [33]. The findings of present study also showed the idealism of aesthetic leaders in the organization. Being a role model and practicality of leaders are among intellectual -based aesthetic actions that confirm the findings of previous studies. Wise leaders use moral compass to set boundaries for their behavior, keep their promises, and align their actions with their speech [34]. Aesthetic leaders in this study also referred to the alignment of thought, speech and actions as an expression of intellectual -based aesthetics, and also tried to build trust among the stakeholders. According to our findings, trust in speech is an example of intellectual -based aesthetic speech. Hassi and Storti (2023) proved that leaders with intellectual -based characteristics, by creating a positive organizational climate and supportive work environments, are more effective in retaining employees and increasing their organizational commitment. Aesthetic leaders in this study also had some concerns over nurses\u0026rsquo; welfare and standards, and were in favor of creating a supportive work environment. The participants referred to the creation of organizational commitment for employees as a kind of aesthetics in the organization, so they were trying to create a positive organizational atmosphere.\u003c/p\u003e\n\u003cp\u003eIt can be argued that the common ground of aestheticism and intellectual, is tacit knowledge, strong senses and emotions, and intuition. Based on previous studies, intellectual is one of the qualities that leaders need. Aesthetic-oriented leaders with benevolence, which are the main components of intellectual, deal with the management of problems in the organization and its employees. As mentioned, the components of intellectual correspond to those of beauty from the perspective of aesthetic leaders in our study. Morality and spirituality are also important component of intellectual. Aesthetic leaders who have intellectual guide the issues they face and give meaning to them. They also use their intellectual to achieve excellence. The wise aesthetic leaders can achieve spirituality and realize their potential abilities gained through interaction with the world. intellectual enables these leaders to take advantage of any situation in life and move towards spiritual and moral excellence, which is the ultimate goal of human creation [35]. In this study, we formulated a following definition for intellectual -based aesthetics based on the interviews conducted with the aesthetic leaders and review of the available texts:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;intellectual -based aesthetics is a kind of integrated and coherent thinking (thought) around a situation that causes aesthetic actions (speech and actions), guiding the situation and giving meaning to it\u0026rdquo;.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBy examining the interviews of aesthetic leaders, it may be possible to reach a new definition of aesthetics in the organization and subsequently in the health care system: \u0026ldquo;Aesthetics is a pleasant phenomenon in the professional life of nurses. In this study, an attempt was made to explain the position of aesthetics in Iranian nursing leadership by presenting definitions of aesthetic in thought, speech, and actions pf nursing leaders.\u003c/p\u003e\n\u003cp\u003eThe findings of this study consolidate the findings of previous studies in terms of theoretical foundations for the development of aesthetic literature and aesthetic leadership. In terms of methodology, this study presents an aesthetic nursing leadership model in the health care system in order to create a therapeutic environment, which is dynamic, cheerful and creative. Since aesthetic structure may not always be observed directly in the organization, recognizing the aesthetic characteristics that exist in nursing leaders (thoughts, speech and actions), helps to create an aesthetic organization and protect existing aesthetic values.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study is derived from MS of nursing thesis, and researchers would like to express sincere appreciation to the Nursing Management and Leadership Team of Medical Sciences Hospitals who contributed to this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNP collected the data and wrote the manuscript. MACH supervised the thesis and controlled the entire process, including editing the manuscript. ME and FHB provided consultation for the thesis and assisted with interpretation. MACH and NP analyzed the data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe obtain approval from the Joint Committee of Organizational Ethics of Tehran University of Medical Sciences. (Code: IR.TUMS.FNM.REC.1401.122).Informed consent was obtained from the nursing managers and leaders to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo patient or public contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur manuscript is a descriptive qualitative article, in which the necessary data was obtained by interview, and at the beginning of interveiw, informed consent was obtained from the nursing leaders and managers to participate in the study. Participants were assured of the confidentiality of the information. This study is not an interventional study, so did not require any intervention on nurses or patients or anyone else.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGahlot S, Bathla A. Aesthetic Leadership: A Review. FOCUS. 2021;23(4):39.\u003c/li\u003e\n\u003cli\u003eNajafi F, Cheraghi M, Pashaeipour S, Ghane G, editors. Clarifying the concept of the four‐season symphony (I SEA) in nursing practice: A Wilson\u0026apos;s approach to concept analysis. Nursing Forum; 2021: Wiley Online Library.\u003c/li\u003e\n\u003cli\u003eGhane G, Cheraghi MA, Pashaeypoor S, Najafi F, editors. Concept analysis of the Four‐Season‐Symphony of Intellectuality\u0026ndash;Spirituality\u0026ndash;Ethics\u0026ndash;Esthetics (FSS: I SEA) in nursing research. Nursing Forum; 2021: Wiley Online Library.\u003c/li\u003e\n\u003cli\u003eHarris AM. 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Introducing Kant: A Graphic Guide: Icon Books Ltd; 2015.\u003c/li\u003e\n\u003cli\u003eBarnawi NA. Concept Analysis of Nursing Wisdom. Biomedical Journal of Scientific \u0026amp; Technical Research. 2019;23(1):17179-88.\u003c/li\u003e\n\u003cli\u003eHassi A, Storti G. Wise leadership: construction and validation of a scale. Modern Management Review. 2023;28(1):47-69.\u003c/li\u003e\n\u003cli\u003eElhattab NEMM. Does wisdom leadership drive employee advocacy and retention in tavel agencies? Journal of the Faculty of Tourism and Hotels-University of Sadat City. 2024;8(1/2).\u003c/li\u003e\n\u003cli\u003eOgunyemi O, Ogunyemi K. Authentic leadership: leading with purpose, meaning and core values. New Horizons in Positive Leadership and Change: A Practical Guide for Workplace Transformation. 2020:369-80.\u003c/li\u003e\n\u003cli\u003eVerhezen P. A corporate governance perspective on organisational integrity. Research Handbook on Organisational Integrity: Edward Elgar Publishing; 2024. p. 280-300.\u003c/li\u003e\n\u003cli\u003eSadat Hoseini AS, Mohammadi M. The concept of intellectual nursing: literature review. Islamic Studies in Health. 2021;5(1):47-58.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Aesthetics, leadership, nursing","lastPublishedDoi":"10.21203/rs.3.rs-5296193/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5296193/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and objective:\u003c/strong\u003e Aesthetics can be explained and investigated in two contexts of beauty and sublimity. Aesthetics is often considered as a specific method of sensory perception or experience. Findings of qualitative studies should be used to objectify aesthetics in all areas of nursing, including management and leadership. This study was conducted in 2023 to explain the position of aesthetics in Iran’s nursing leadership in the teaching hospitals of Tehran University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e This is a descriptive and qualitative study with conventional content analysis approach suggested by Granheim and Lundman. Research community included the leadership and management team of hospitals affiliated to Tehran University of Medical Sciences. Semi-structured and face-to-face individual interviews (28 in total) were conducted with the participants ( director nurses and supervisors and head nurses) to collect the data. purposeful and snowball methods were used for the sampling, which continued until data saturation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e: A total of 1482 codes were extracted from 28 interviews, which were later summarized in three main categories (aesthetic thought, aesthetic speech and aesthetic action) and nine subcategories.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This study consolidates the findings of previous studies in terms of theoretical foundations of aesthetic leadership in the literature, and in regard to methodology, it facilitates the complementation of aesthetic nursing leadership model in the health care system. Therefore, it can help to objectify and explain the concepts of beauty and sublimity in the organizational life of nursing leaders in Iran's health care system.\u003c/p\u003e","manuscriptTitle":"Explaining the position of aesthetics in Iran’s nursing leadership","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-06 11:44:31","doi":"10.21203/rs.3.rs-5296193/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"24d4806b-8fdd-4a69-b96b-58730d140529","owner":[],"postedDate":"November 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-11T20:53:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-06 11:44:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5296193","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5296193","identity":"rs-5296193","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}