Hofling Hospital Experiment Final Term Paper

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Cassandra N. Phillips
Keiser University
December 11, 2012
PSY 1012-Introduction to Psychology
Professor Balkaran

In 1966, the psychiatrist Charles K. Hofling conducted a two-part experiment that was inspired by Milgram’s research in obedience (Milgram, S., 1963 & 1965). It consisted of a survey and field study on obedience in the nurse-physician relationship. Primarily, what happens when nurses are required to carry out a procedure which goes against her professional standards and secondly, to determine if nurses were aware of their tendencies in the level of obedience they displayed.

The Method, Participants, & Materials
Three psychiatric hospitals in the Midwest took part in this study, with one hospital acting as the control group. The control group consisted of a total of twenty-two nurses (twelve graduate nurses and twenty-one student nurses) who would complete the survey during the field study period. The field experiment would be conducted in twenty-one wards (twelve public and ten private) of the remaining two psychiatric hospitals. The twenty-two nurse participants were closely matched for age, sex, race, marital status, length of working week, professional experience and area of origin. An imaginary scenario was explained to the group of nurses and nursing students who were not only expected to answer what they would do, but also what they predicted the majority of other nurses would do in the same situation (Hofling, Brotzman, Dalrymple, Graves & Pierce,1966).

Hofling then arranged for a memo to be sent to all of the participants to remind them of their responsibilities with regard to changes in medication for patients. The nurses were observed to see if they adhered to the guidelines provided otherwise a violation of hospital policy would have transpired. Per the memo, (1) medication orders and instructions could not be accepted over the phone, (2) no more than the maximum dosage stated on authorized medication could be ordered, (3) unauthorized medication, such as those medications that are not on the ward stock list, could not be administered, (4) all medication orders and instructions must be signed by the physician prior to giving the patient the medication, and (5) identification must be presented by the physician if unknown. A pill box containing 5mg capsules of the placebo “Astroten” was supplied in advance with a label advising a maximum daily dosage of 10 mg.

A call was placed during the hours of 7 p.m. and 9p.m., in which an unknown doctor (Dr. Smith) would request that the patient (Mr. Jones) be given 20 mg of Astroten prior to his arrival later. Standard responses to potential questions were prepared by the researchers who monitored and recorded the conversations. An observer was present on each ward to terminate the experiment should: (1) a nurse comply with the doctor’s order, (2) the nurse refuse the request, (3) the nurse contact another professional, (4) the participant become emotionally distressed, (5) be unable to locate the medication, or (6) the call be extended more than ten minutes. A physician researcher would stop the nurses that were ready to administer the “Astroten” and debriefed them within 30 minutes of the telephone conversation. At the debriefing, the audiotape of the call would be played and the nurse would be interviewed for more detailed information. Results

Results from the survey indicated twenty-one out of the twenty-two nurses that participated believed they would not obey the doctor and go against hospital procedures. Most believed other nurses would behave in the same way. Hofling found that twenty-one out of the twenty-two nurses in the field study would have given the patient an overdose of medicine as those nurses fulfilled the physician’s order. From the twenty-one nurses that complied, eleven said they did not notice the amount was an overdose...
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