دانلود رایگان مقاله انگلیسی رابطه بین فرهنگ سازمانی و استفاده از داروهای روانگردان در خانه های پرستاری - اشپرینگر 2018

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-forgranted 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.

6 Conclusions

Studies have suggested that organizational culture influences the use of psychotropic medicines in nursing homes, however this is currently supported by a relatively limited number of studies that explain the role of organizational culture only at the surface level. Further research using a clear theoretical basis of organizational culture is required. This will allow a comprehensive assessment of what part of the organizational culture influences the use of psychotropic medicines and why. It is only then we can decide on how to address organizational culture to improve psychotropic medicine use in nursing homes. This review highlights the complexities of, and challenges associated with, investigating organizational culture, and confirmed Schein’s theory as a useful framework to assess the role of organizational culture in healthcare practices.