Experimental Study in Nurse-Physician Relationships (Hofling et al., 1966)

Experimental Study in Nurse-Physician Relationships (Hofling et al., 1966)

1. Aim

   • To investigate aspects of the nurse-physician relationship, specifically what happens when a nurse is ordered to carry out a procedure which goes against her professional standards

2. Procedure

   • 12 graduate nurses, 21 student nurses, asked to fill a questionnaire about what they would do if confronted by the experimental situation
   • 22 nurses from 2 other hospitals doing normal duties were targeted for the actual field experiment
   • While alone on the ward, they recieve a phone call from an unknown doctor
   • 3 hospitals in Midwest USA, one control
   • The nurse was asked to give an overdose of a drug to a patient
     • Really a placebo
   • Medication order is given over the phone by the doctor
     • Hospital policy requires such orders are given in person
   • The drug in unauthorised for use on the ward where she is working
   • The order is given by an unfamiliar voice

3. Resullts

   • Questionnaire
     • 10/12 graduate nurses and all 21 students said they would not have given the medication
       • Most believed other nurses would do the same
   • Experiment
     • 21/22 nurses tested started to give the medication
     • The calls were generally brief without any resistance
     • During debriefing, only 11 nurses were aware of the dosage limits for Astroten, none became hostile toward the caller and nearly all aditted that they should not have followed these orders as it is against hospital policy, but stated that it was a fairly common occurance.

4. Conclusion

   • Nurses will knowingly break hospital rules in a situation where a doctor tells them to, even if it could endanger a patients life

5. Evaluation

   • Validity
     • Ecological
       • High. Nurses were unaware, and it was a field study
     • Population
       • High. Nurses chosen 'at random'
       • Just USA
     • Experimental
       • High. None of the nurses were aware it was a set up
   • Ethics
     • No informed consent, but this was necessary
     • Debriefing
     • Put under pressure
   • Reliability
     • Was reliable. Ran 22 times, procedure and conditions kept the same throughout
     • Field study, impossible to control all extraneous variables