Hofling hospital experiment

In 1966, the psychiatrist Charles K. Hofling conducted a field experiment on obedience in the nurse-physician relationship. In the natural hospital setting, nurses were ordered by unknown doctors to administer what could have been a dangerous dose of a (fictional) drug to their patients. In spite of official guidelines forbidding administration in such circumstances, Hofling found that 21 out of the 22 nurses would have given the patient an overdose of medicine.

Procedure

A doctor unknown to a nurse would call her by telephone with orders to administer 20 mg of a fictional drug named "Astroten" to a patient and that he/she will sign for the medication later. The bottle had been surreptitiously placed in the drug cabinet, but the "drug" was not on the approved list. It was clearly labelled that 10 mg was the maximum daily dose.

The experimental protocol was explained to a group of nurses and nursing students, who were asked to predict how many nurses would give the drug to the patient. Of the twelve nurses, ten said they would not do it. All twenty-one nursing students said they would refuse to administer the drug.

Hofling then selected 22 nurses at a hospital in the United States for the actual experiment. They were each called by an experimenter with the alias of Dr. Smith who said that he would be around to write up the paperwork as soon as he got to the hospital. The nurses were stopped at the door to the patient room before they could administer the "drug".

There were several reasons that the nurses should have refused to obey the authority. 1.) The dosage they were instructed to administer was twice that of the recommended safe daily dosage. 2.) Hospital protocol stated that nurses should only take instructions from doctors known to them, therefore they should definitely not have followed instructions given by an unknown doctor over the phone. 3.) The drug was not on their list of drugs to be administered that day and the required paperwork to be filled before drug administration was not completed.

Findings

Hofling found that 21 out of the 22 nurses would have given the patient an overdose of medicine. None of the investigators, and only one experienced nurse who examined the protocol in advance, correctly guessed the experimental results. He also found that all 22 nurses whom he had given the questionnaire to had said they would not obey the orders of the doctor, and that 10 out of the 22 nurses had done this before, with a different drug.

Conclusions

The nurses were thought to have allowed themselves to be deceived because of their high opinions of the standards of the medical profession. The study revealed the danger to patients that existed because the nurses' view of professional standards induced them to suppress their good judgement.

Books

• Basic Psychiatric Concepts in Nursing (1960). Charles K. Hofling, Madeleine M. Leininger, Elizabeth Bregg. J. B. Lippencott, 2nd ed. 1967: ISBN 0-397-54062-0
• Textbook of Psychiatry for Medical Practice edited by C. K. Hofling. J. B. Lippencott, 3rd ed. 1975: ISBN 0-397-52070-0
• Aging: The Process and the People (1978). Usdin, Gene & Charles K. Hofling, editors. American College of Psychiatrists. New York: Brunner/Mazel Publishers
• The Family: Evaluation and Treatment (1980). ed. C. K. Hofling and J. M. Lewis, New York: Brunner/Mazel Publishers
• Law and Ethics in the Practice of Psychiatry (1981). New York: Brunner/Mazel Publishers, ISBN 0-87630-250-9
• Custer and the Little Big Horn: A Psychobiographical Inquiry (1985). Wayne State University Press, ISBN 0-8143-1814-2

See also

• Milgram experiment

External links

• Obedience studies