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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 determine what technological strategies were used within each of the phases of the ADDIE framework when developing content for professional training. The study also examined the affordances of those technologies in training.

A PRISMA systematic review methodology (Moher et al., 2015) was utilized to answer the four questions guiding this study. Specifically, the PRISMA extension Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols (PRISMA-P, Moher et al., 2015) was used to direct each stage of the research, from the literature review to the conclusion. In addition, the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA principles; Liberati et al., 2009) are used to guide the article selection process.

The findings reveal that the majority of the studies were in healthcare (36%) and education (24%) and used an online format (65%). There was a wide distribution of ADDIE used with technology across the globe. The coding for the benefits of technology use in the development of the training solution revealed four trends: 1) usability, 2) learning approaches, 3) learner experience and 4) financial.

This systematic review only examined articles published in English, which may bias the findings to a Western understanding of how technology is used within the ADDIE framework. Furthermore, the study examined only peer-review academic articles from scholarly journals and conferences. While this provided a high level of assurance about the quality of the studies, it does not include other reports directly from training providers and other organizations.

These findings can be used as a springboard for training providers, scholars, funders and practitioners, providing rigorous insight into how technology has been used within the ADDIE framework, the types of technology, and the benefits of using technology. This insight can be used when designing future training solutions with a better understanding of how technology can support learning.

This study provides insight into the uses of technology in training. Many of these findings and uses of technology within ADDIE can also transfer to other aspects of society.

This study is unique in that it provides the scholarly community with the first systematic review to examine what technological strategies were used within each of the phases of the ADDIE structure and how these technologies provided benefits to developing a training solution.