Garcia, Lian Louis L.

2018-06035
Response Paper #1: A Critical Analysis of "An Experimental Study in Nurse-Physician Relationships"

Charles K. Hofling, a psychiatrist, created a field research that measured the concept of obedience
in the nurse-physician relationship. The experiment aims to investigate aspects of the nurse-physician
relationship when a nurse is asked to accomplish a procedure that goes against her professional standards.
To administer the study, Hofling used an experimental research design. The procedures and variables,
such as the standardized telephone order and the stimulus call, were controlled. In addition to that, there is
also a control group- the graduate and student nurses, used in the study to make comparisons with the
findings from the experimental group- the nurses in the hospital wards.

The study was conducted both in public and private hospital wards. The control group, the
twenty-one nursing students and twelve graduate nurses, was in the first hospital, and they were asked to
answer a questionnaire about the possible experimental situations. In other hospitals, twenty-two nurses
were included in the experiment, which was covert. The nurses (from the experimental group), who were
on a night shift, received a phone call from an unknown doctor asking them to administer 20 milligrams
(mg) of astroten, a fictitious drug, to a patient. The amount of drug nurses were instructed to give was an
overdose, but the drug was a harmless sugar pill (placebo) made for the experiment. Also, the doctor
assured the nurse to sign and provide the written order later. The telephone order termination and the
observer's interruption include the nurse's compliance, refusal, distress, and other situations that may or
may not be necessary to the experiment.

The questionnaire's findings said that, in the control group, ten of the graduate and all of the
student nurses would not administer the drug. Whereas in the experimental group, out of twenty-two,
twenty-one nurses obeyed the doctor's orders, and only one nurse was skeptical about the doctor's
identity. In addition to that, eleven nurses who chose to give the instructed medication admitted that they
know the dosage discrepancy. While the others acknowledged their lack of awareness of it but deemed
that it was safe since it was a doctor who had directed them to do so. Assumed from the experiment
results, nurses respond to situations similar to the experiment, on the basis of the transference to the
doctor. They may consciously break hospital policies even if it could endanger a patient's life, just to
avoid causing frustration or annoyance to the doctor. Lastly, this study shows the unequal power relations
between doctors and nurses, in which nurses, at times, lead to compromising their conscious professional
standards.

In my perspective, Hofling's hospital experiment, although questionable in some areas, has

reasonably met all ethical guidelines. One matter that could have been considered unethical is deception
since no informed consent was given to the participants. Hence, they were clueless that they were subjects
involved in a study, and also neither the doctor nor the drug used was real. On the contrary, all nurse-
participants were debriefed within thirty minutes after the experiment ended to guarantee no lasting
distress and psychological harm. The participants' protection was at the top priority, and they should not
have had any harmful effects mentally because of what they had reacted during the experiment. Also, the
nurses were not named, and only statistical numbers were used, so confidentiality was utmost maintained.
This ethical guideline was crucial because the nurses would not be personally targeted for their
unprofessional acts or behavior because of disobedience to the hospital policy, even if they admit to
violating it. Furthermore, the nurses could not voluntarily withdraw from the experiment since they do not
know about it. Yet, in my opinion, the nurses could still freely decide whether to carry out the doctor's
order or not, so the withdrawal from the study guideline was, somehow, kept. In the entirety of Hofling's
hospital experiment, ethical guidelines were still observed. Regarding the matter of deception, if consents
were given to the nurses, and they were advised about the experiment, then it could have affected the
results. The study would not have worked. Thus, informing the nurses as subjects is not necessary since
the aim of Hofling's experiment is to create a realistic study of obedience about nurse-physician
relationships.