9.5: 服从

According to obedience research, we may harm others under the forceful pressures of an authority figure (Milgram, 1974). How about if the inappropriate orders were delivered with less force? The increasing interdependence between nurses and physicians compelled Hofling and his colleagues to explore nurses’ reactions to a potentially harmful medical request made by the perceived authority figure, the doctor (Hofling, Brotzman, Dalrymple, Graves, & Pierce, 1966). In this situation, obedience describes the submission of a request or demand with low protest or resistance.

Experimental Study on Nurse and Physician Relationships

A field study led by Hofling (1966) examined differences between written and genuine reactions to scenarios involving obvious hospital violations enacted by a doctor. Would nurses comply to a doctor’s phoned request to dispense an unfamiliar drug at a dosage that exceeded amount restrictions on a warning label? As expected, all participants in the questionnaire condition reported that they would not give the medication. Yet in the field study condition, 21 out of 22 nurses administered the drug as directed with minimal hesitation. They later reported negative feelings of embarrassment, mild anxiety and guilt during post interviews.

Inconsistencies found between questionnaire reactions and authentic responses suggest that we may overstate our ability to overcome perceived pressures from others when placed in similar situations. Nurses under the questionnaire condition and several of the investigators in the Hofling study (1966) did not expect many nurses to comply. Of note, later replications of Milgram’s highly publicized research findings on obedience strongly suggest that awareness of forces underlying social pressures does not necessarily reduce people’s tendency to comply to authority under actual situations (See Bocchiaro & Zamperini, 2012).

Overcoming Compliance

Compliance may be strengthened by workplace conditions that undermine the skills, knowledge, and a sense of purpose nurses receive in their formal education. A replication of the Hofling’s study (1966) revealed that the opportunity to discuss decisions with others successfully reduced compliance (Rank & Jacobsen, 1977). A separate study concluded that an increased sense of personal responsibility distinguished non-compliant from compliant nurses (Krackow & Blass, 1995). However, a sense of duty to challenge questionable practices may not overcome the need for acceptance by their team (Levett-Jones & Lathlean, 2009). A work climate that lessens inhibitions from exercising sound judgements is thus vital to optimal patient care and safety.

Can you think of other situations in which compliance to dubious requests may place others in great danger? How do you think you would respond? Are you sure?

Sometimes, people are willing to go against their personal standards and obey commands that may result in harm. This form of social influence is called obedience—following orders or requests from perceived figures of authority.

For example, during one original field study—in a natural hospital setting—an alleged doctor, in this case the authority, ordered nurses over the phone to administer an “unknown” drug, one that was not on the officially approved list, and, exceeded the maximum safe daily dose. In reality, the drug was a placebo.

The nurses—at least 95% of them—proceeded to honor the “doctor’s” orders, even though it was against protocol and doing so could have resulted in fatality of the patient.

Interestingly, in the control group, nurses were simply asked what they would do in a similar situation. The same percentage, 95%, said they would NOT obey with the orders given.

Thus, when people are placed in the actual situation, they may act against their own better judgment.