Charles K. Hofling

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Charles K. Hofling was a psychiatrist, author, and editor whose most famous research work was a 1966 study of obedience to authority in the medical field.

1 Obedience study
2 Books
3 See also
4 References
5 External links

[edit] Obedience study

[edit] Aim

The aim of the experiment was to examine obedience to authority in a real life situation in a hospital.^[1]

[edit] 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. The bottle had been surreptitiously placed in the drug cabinet, but the "drug" was not on the approved list. It was clearly labeled 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. Ten out of twelve nurses asked, said they would not do it. Of 21 nursing students questioned, all of them 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

[edit] 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 from the 22 nurses that he gave the questionnaire to, all of them had said they would not obey the orders of the doctor; he also found that 10 out of the 22 nurses had done this before, with a different drug.

[edit] 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.

[edit] Criticism

Because it was a field experiment, it had high ecological validity and experimental validity. However, in order to do the experiment truthfully, the nurses had to be denied informed consent. The nurses were accustomed to accepting advice from authority figures. Finally, the medicine used was fictional. When the experiment was repeated with Valium, a drug with which the nurses were acquainted, none of the nurses obeyed.

Although there are many other factors that would have contributed to the nurse's decision. In 1966 there probably weren't any procedures for nurses to check on a doctor or to check the decision of a doctor and in most hospitals nurses were thought as as the second-rung profession below doctors, so there was not a culture of challenging doctor's decisions. Furthermore the experiment made the doctor's orders sound very important: a rare drug, high dosage, and seemingly so important that the doctor had to phone in, as though he couldn't get to the hospital quick enough. The decision of the nurses came not just out of an appreciation for the authority and status of the doctor, but also stems from the institutional culture and decision-making procedures in that particular hospital.

[edit] 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