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Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

The purpose of this study is to propose a framework for the convergence of maturity model and education and evaluation in accounting.

The present research was conducted in two phases. In the first phase, to determine the indicators of convergence of the maturity model and education and evaluation in accounting, a Meta-Synthesis method was used. The conceptual model includes two dimensions of “Teaching and learning processes” and “Evaluation methods"; five levels of initial, repeatable, defined, managed and optimized; and a total number of 35 indicators. In the second phase, a questionnaire was developed, and academics as accounting faculty members in Iranian public universities were employed to fill out the questionnaire electronically and present a final framework. Having received the questionnaires, 66 questionnaires were analyzed statistically.

The results showed that the two dimensions of “Teaching and learning processes” and “Evaluation methods” considering initial, repeatable, defined, managed and optimized levels include 35 indicators, which form a framework for the convergence of maturity model and education and evaluation in accounting. The results show that both dimensions have positive and significant regression path coefficients in the convergence model. Moreover, the dimension of teaching and learning processes has the highest regression path coefficient indicating a greater impact on the convergence model. Besides, all five levels have positive and significant regression path coefficients with dimensions. Finally, in this study, all indicators were prioritized according to five levels.

Due to the success of maturity models and the urgent developments that require transformative improvements in accounting education, maturity models can respond to the challenges associated with education and learning in accounting. Thus, conceiving an image of the convergence of maturity model, education and evaluation in accounting seems imperative which has been scarcely investigated previously.