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Drugs & Aging

, Volume 35, Issue 3, pp 189–211 | Cite as

Relationship between Organizational Culture and the Use of Psychotropic Medicines in Nursing Homes: A Systematic Integrative Review

  • Mouna Sawan
  • Yun-Hee Jeon
  • Timothy F. Chen
Systematic Review

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.

Notes

Author contributions

All authors contributed to the study concept and design, analysis and interpretation of data, and preparation of the manuscript.

Compliance with Ethical Standards

Conflict of interest

Mouna J. Sawan, Yun-Hee Jeon, and Timothy F. Chen have no financial or other personal conflicts with this paper.

Funding

The authors received no financial support or grants for the research, authorship, and/or publication of this article.

Supplementary material

40266_2018_527_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of PharmacyThe University of SydneyCamperdownAustralia
  2. 2.Faculty of Nursing and MidwiferyThe University of SydneyCamperdownAustralia

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