Hofstede's cultural dimensions as the explanatory framework for performance issues during clinical placement : a mixed methods study

Aims and objectives: The objectives of this study were to examine a) if those with reported clinical performance issues were more likely to experience course progression issues or withdrew from the program; b) the relationship between clinical and academic performance; c) the relationship between students social-demographic characteristics and clinical performance issues; and d) the utility of Hofstede's cultural dimensions theory in explaining the clinical performance issues students may experience during clinical placement. Method: Retrospective textual reports of clinical issues from 2014 to 2018 were collected. A mixed methods design, particularly Embedded Design, was used. The qualitative data was analysed using Directed Content Analysis using Hofstede's six dimensions as the coding categories, which were further broken down into high and low poles, making a total of 12 subcategories. Univariate and multivariate logistic regression was utilised to analyse the quantitative data. Results: Using Hofstede's framework, it was determined that nursing students 21 years and younger were more likely to have issues related to low long-term orientation. Male students were more likely to have issues related to low uncertainty avoidance and also displayed masculinity related issues. Overseas-born students were less likely to experience issues related to low power distance and students that had not failed a unit of study were less likely to have issues related to low long-term orientation. The study also found that students experienced issues related to poor psychomotor skills and language barriers. Furthermore, the study identified that students who experienced clinical placement issues were three times more likely to leave the course. Conclusion: Hofstede's cultural dimensions framework can be used to explain clinical performance issues among undergraduate nursing students. Early identification of the students likely to experience these issues can lead to targeted and preventative interventions.