Hofling et al. (1966) - Hospital Obedience Study

• Hofling's study, carried out as part of a real hospital's normal routine, is significant because of it's alarming findings.

AIM:

• To see whether nurses would obey orders from an unknown doctor to such an extent that there would be risk of harm.

METHOD:

• Nurses selected by genuinely being on duty on an evening shift.
• Confederate "Doctor Smith", unknown to nursing staff, instructed 22 nurses individually by phone to give his patient 20mg of an unfamiliar drug, Astrofen (actually a sugar pill).  He was in a hurry, would sign the authorisation form later.
• Label on box of medicine stated the max. daily dose as 10mg.
• Hospital rules required doctors sign authorisations before medication was given. Also that nurses should be certain anyone giving medical instructions was a genuine doctor.
• If it appeared that the nurse was about to administer the fake drug, observer doctor intervened.
• All nurses de-briefed within 30 mins of the end of the call.

FINDINGS:

• 21 of 22 nurses obeyed without hesitation.
• During debriefing only 11 admitted they had noticed the "do not exceed" notice on the packet.
• Control group of 22 nurses asked what they WOULD have done in same situation, 21 said they would NOT have obeyed without authorisation, or exceeded maximum dose.

CONCLUSION:

• The power and authority of the doctors was a greater influence on nurses' behaviour than basic hospital rules.
• What people SAY they will do and what they ACTUALLY do can be very different. Belief is no predictor of behaviour.

EVALUATION:

• Suggests that nurses and institutional staff should have special training in following rules rather than orders from authority figures.
• Hofling's study appears to have high ecological validity, since took place in a real life setting BUT...
• Rank & Jacobsen (1977) reported that the drug was unfamiliar to nurses.  Also they had not been allowed to consult each other with as was normal practice, so no chance to check out fake drug.
• When familiar drug, Valium, was used and they were allowed to speak with their peers, only 2 of 18 nurses obeyed, suggesting Hofling's study may not have external validity.
• Having more knowledge (ISI) empowered the nurses in this later study to reject the doctor's commands.

• Study supports AGENCY THEORY as nurses did not feel they needed to take responsibility as that was the role of the doctor. They were just doing what was asked of them.
• Study has population validity since it was a real situation where nurses were working.
• Was a field study therefore has high experimental validity.
• Nurses were NOT able to give informed consent.
• Some of the nurses were very distressed.
• 15 of the 21 nurses could recall similar incidents in real life.  NB.  There is a 12% daily error rate for such things in the USA.  It is considered that this is due to the "unquestioning deference to authority that doctors demand and nurses expect". Hofling et al (1966).