Mouna Sawan1, Yun-Hee Jeon2, Timothy F Chen3. 1. Faculty of Pharmacy, The University of Sydney, N507, Pharmacy and Bank Building (A15), Camperdown, NSW, 2006, Australia. mouna.sawan@sydney.edu.au. 2. Faculty of Nursing and Midwifery, The University of Sydney, M02A, 88 Mallett Street, Building A, Camperdown, NSW, 2006, Australia. 3. Faculty of Pharmacy, The University of Sydney, N507, Pharmacy and Bank Building (A15), Camperdown, NSW, 2006, Australia.
Abstract
BACKGROUND: Psychotropic medicines are commonly used in nursing homes, despite marginal clinical benefits and association with harm in the elderly. Organizational culture is proposed as a factor explaining the high-level use of psychotropic medicines. Schein describes three levels of culture: artifacts, espoused values, and basic assumptions. OBJECTIVE: This integrative review aimed to investigate the facets and role of organizational culture in the use of psychotropic medicines in nursing homes. METHOD: Five databases were searched for qualitative, quantitative, and mixed method empirical studies up to 13 February 2017. Articles were included if they examined an aspect of organizational culture according to Schein's theory and the use of psychotropic medicines in nursing homes for the management of behavioral and sleep disturbances in residents. Article screening and data extraction were performed independently by one reviewer and checked by the research team. The integrative review method, an approach similar to the method of constant comparison analysis was utilized for data analysis. RESULTS: Twenty-four studies met the inclusion criteria: 13 used quantitative methods, 9 used qualitative methods, 1 was quasi-qualitative, and 1 used mixed methods. Included studies were found to only address two aspects of organizational culture in relation to the use of psychotropic medicines: artifacts and espoused values. No studies addressed the basic assumptions, the unsaid taken-for-granted beliefs, which provide explanations for in/consistencies between the ideal use of psychotropic medicines and the actual use of psychotropic medicines. CONCLUSIONS: Previous studies suggest that organizational culture influences the use of psychotropic medicines in nursing homes; however, what is known is descriptive of culture only at the surface level, that is the artifacts and espoused values. Hence, future research that explains the impact of the basic assumptions of culture on the use of psychotropic medicines is important.
BACKGROUND: Psychotropic medicines are commonly used in nursing homes, despite marginal clinical benefits and association with harm in the elderly. Organizational culture is proposed as a factor explaining the high-level use of psychotropic medicines. Schein describes three levels of culture: artifacts, espoused values, and basic assumptions. OBJECTIVE: This integrative review aimed to investigate the facets and role of organizational culture in the use of psychotropic medicines in nursing homes. METHOD: Five databases were searched for qualitative, quantitative, and mixed method empirical studies up to 13 February 2017. Articles were included if they examined an aspect of organizational culture according to Schein's theory and the use of psychotropic medicines in nursing homes for the management of behavioral and sleep disturbances in residents. Article screening and data extraction were performed independently by one reviewer and checked by the research team. The integrative review method, an approach similar to the method of constant comparison analysis was utilized for data analysis. RESULTS: Twenty-four studies met the inclusion criteria: 13 used quantitative methods, 9 used qualitative methods, 1 was quasi-qualitative, and 1 used mixed methods. Included studies were found to only address two aspects of organizational culture in relation to the use of psychotropic medicines: artifacts and espoused values. No studies addressed the basic assumptions, the unsaid taken-for-granted beliefs, which provide explanations for in/consistencies between the ideal use of psychotropic medicines and the actual use of psychotropic medicines. CONCLUSIONS: Previous studies suggest that organizational culture influences the use of psychotropic medicines in nursing homes; however, what is known is descriptive of culture only at the surface level, that is the artifacts and espoused values. Hence, future research that explains the impact of the basic assumptions of culture on the use of psychotropic medicines is important.
Authors: Linda Simoni-Wastila; Yu-Jung Wei; Mario Luong; Christine Franey; Ting-Ying Huang; Gail B Rattinger; Ilene H Zuckerman; Nicole Brandt; Judith A Lucas Journal: Res Social Adm Pharm Date: 2013-11-15
Authors: Paula A Rochon; Therese A Stukel; Susan E Bronskill; Tara Gomes; Kathy Sykora; Walter P Wodchis; Michael Hillmer; Alexander Kopp; Jerry H Gurwitz; Geoffrey M Anderson Journal: Arch Intern Med Date: 2007-04-09
Authors: Jo Thompson Coon; Rebecca Abbott; Morwenna Rogers; Rebecca Whear; Stephen Pearson; Iain Lang; Nick Cartmell; Ken Stein Journal: J Am Med Dir Assoc Date: 2014-08-08 Impact factor: 4.669
Authors: Dallas P Seitz; Sudeep S Gill; Nathan Herrmann; Sarah Brisbin; Mark J Rapoport; Jenna Rines; Kimberley Wilson; Ken Le Clair; David K Conn Journal: Int Psychogeriatr Date: 2012-10-19 Impact factor: 3.878
Authors: Hemalkumar B Mehta; Yong-Fang Kuo; Mukaila A Raji; Jordan Westra; Cynthia Boyd; G Caleb Alexander; James S Goodwin Journal: J Am Med Dir Assoc Date: 2021-05-19 Impact factor: 4.669