Learning Objectives
1. Describe and discuss the hierarchy of needs, from the simple to the complex, as developed by Maslow.
2. Define the term regression and explain at least two examples of regression.
3. List at least five physiologic needs of all people and animals.
4. List five examples of nursing activities that help an individual meet basic physiologic human needs.
5. List four examples of nursing activities that help an individual meet the needs of security and safety.
6. List two examples of nursing activities that help an individual obtain the goal of self-esteem.
7. List two examples of nursing activities that help an individual obtain the goal of self-actualization.
8. Address the basic and aesthetic needs of individuals who are homeless, who have a terminal illness, or who have lost their jobs and source of income.
9. Relate at least three community or societal needs to the hierarchy of needs of an individual.
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IMPORTANT TERMINOLOGY |
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aesthetic needs |
psychological needs |
self-esteem |
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hierarchy of needs |
regression |
social needs |
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physiologic needs |
secondary needs |
survival needs |
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primary needs |
self-actualized |
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In 1943, psychologist Abraham H. Maslow described a theory of human needs that identified simple basic needs in relation to the more complex, higher-level needs. These needs are common to all people regardless of age, sex, race, social class, and state of health (well or ill). Maslow asserted that people respond to needs and need satisfaction as whole and integrated beings.
Nursing has been defined as a helping relationship. As a nurse, you will help people to satisfy their basic needs and to reduce threats to this need fulfillment.Most types of nursing care are prioritized using the same hierarchy. This topic summarizes human needs and explains their relationship to health and nursing care.
MASLOW’S HIERARCHY OF NEEDS
Maslow defined the basic needs of all people as a progression from simple physical needs (needed for survival) to more complex ones, called aesthetic needs. He called this progression a hierarchy of needs. On this hierarchy or ladder (Fig. 5-1), needs are ranked by their importance to the individual’s survival.
A person must meet the needs at the foundation of the hierarchy before working toward meeting higher-level needs. Individuals must meet needs at the first level, such as oxygen and food, to survive.
FIGURE 5-1 · Hierarchy of needs. According to Maslow, basic physiologic needs, such as for food and water; must be met before a person can move on to higher-level needs, such as security and safety. Nursing is based on helping people to meet the needs they cannot meet by themselves because of age, illness, or injury.
NCLEX Alert The concepts within Maslow’s Hierarchy of Needs are fundamental components of correct NCLEX options. You may be given more than one correct response but you must choose the best, most appropriate response. Maslow’s Hierarchy often provides clues to the correct answer
After they meet their basic survival needs, people can progress to more complex needs, such as safety, love, and self-esteem. For example, people who are hungry will not be concerned about cleanliness or learning until they are fed. Individuals in pain will not be concerned about personal appearance or relationships with others until pain is relieved. Those facing surgery will not be able to learn about the operation unless they feel safe and secure. Regression, or focusing on a lower-level need that has already been fulfilled, is common in illness or injury. For example, a client recovering from an illness will focus their physical and emotional energies on recovery (physical needs) before returning to employment (security).
NURSING’S RELATIONSHIP TO BASIC NEEDS
Illness or risk for illness occurs when people are unable to satisfy one or more of their basic needs independently. Much of your nursing career will center on assisting people to meet these needs. Nursing also involves helping people to avoid risks or threats to their basic human needs. You will be helping others to prevent complications before they begin.
Many situations will arise in which you will assist clients to meet their needs. You may feed an infant, provide full range of motion for a person who has had a stroke, give a tube feeding to a person who cannot swallow, bathe a person who is in a full body cast, or play with a child. You may encourage the recovering person to attend to personal care, visit with someone who is lonely or frightened, or arrange for a social worker or a member of the clergy to visit. This text discusses issues common to all people, noting that individual needs may be unique. Illness may modify a person’s perception of his or her needs. As a result, the client’s “need priority” may differ from what you would expect. Illness or injury may present a block or obstacle to the meeting of needs. Nursing tries to help remove those obstacles.
Meeting needs is a process; it is never static. In addition, needs are interrelated and some needs depend on others.
Key Concept Nursing is concerned with helping clients meet their physical, spiritual, and psychological needs. Much of nursing deals with assisting clients to meet basic physiologic needs that they cannot meet independently
In many cases, the nurse can determine the client’s level of need satisfaction by looking at him or her. For example, the nurse can estimate oxygenation by looking for cyanosis (blueness of skin) and difficulty breathing. Listening to the client is also helpful. The client may tell the nurse that he or she is hungry, thirsty, or in pain.
Key Concept Basic needs are common to all people; thus, basic needs are universal. Individuals of all cultures have basic needs; in other words, basic needs are transcultural— across all cultures. Needs can be satisfied or they can be blocked during times of illness.
OVERVIEW OF INDIVIDUAL NEEDS
Basic Physiologic Needs
First-level needs are called physiologic needs, survival needs, or primary needs. Without them, a person or animal will die. They take precedence over higher-level needs. Primary needs must be met to sustain life; secondary needs are met to give quality to life. Primary needs are frequently components of NCLEX-PN questions.
Key Concept Primary needs must be met to maintain life. Secondary needs must be met to maintain quality of life.
Oxygen
Oxygen is the most essential of all basic survival needs. Without oxygen circulating in the bloodstream, a person will die in a matter of minutes. Oxygen is provided to the cells by maintaining an open airway and adequate circulation.
As a nurse, you will constantly evaluate the oxygenation status of your clients. Various situations can threaten the body’s oxygen supply. For example, emphysema, asthma, paralysis, or secretions may make breathing difficult; circulation may be impaired, thus preventing oxygen from reaching the cells. Some breathing difficulties also have an emotional component.
Water and Fluids
Water is necessary to sustain life. The body can survive only a few days without water, although certain conditions may alter this length of time. For example, the person in a very hot climate needs more water and fluids to sustain life than the person in a cold climate. The fluids in the body must also be in balance, or homeostasis, to maintain health.
Examples of conditions in which individuals may require assistance to meet their fluid needs include unconsciousness, inability to swallow, and severe mental illness. If the kidneys do not function, the body may retain water in the tissues (edema) or the body may not have enough water (dehydration). The nurse can assist in these conditions by measuring intake and output, weighing the client daily, and observing intravenous infusion of fluids.
Food and Nutrients
Nutrients are necessary to maintain life, although the body can survive for several days or weeks without food. Poor nutritional habits, inability to chew or swallow, nausea and vomiting, food allergies, refusal to eat, and overeating pose threats to a client’s nutritional status. The nurse helps by feeding the client, monitoring calorie counts, or maintaining alternative methods of nutrition such as tube feedings or assisting with intravenous infusions.
Elimination of Waste Products
Elimination of the body’s waste products is essential for life and comfort. The body eliminates wastes in several ways. The lungs eliminate carbon dioxide and water; the skin eliminates water and sodium; the kidneys eliminate fluids and electrolytes; the intestines discharge solid wastes and fluids. If the body should inappropriately allow wastes to accumulate, many serious conditions can result.
A bowel obstruction, bladder cancer, kidney disease, and gallbladder disease disrupt normal elimination. Difficulty in breathing, poor circulation, acid-base imbalance, allergies, cuts, wounds, diabetes, and infection also hinder adequate elimination.
The nurse may help the client eliminate wastes by giving an enema, catheterizing the person, or assisting with dialysis. You may assist with surgery to eliminate a bowel obstruction and administer medications to relieve diarrhea or constipation. You may give oxygen to assist with breathing. You may inject insulin for the diabetic client to aid in proper carbohydrate metabolism.
Sleep and Rest
Sleep and rest are important in maintaining health. The amount of sleep that people need varies; factors such as pregnancy, age, and general health have an influence. The absence of sleep is not immediately life threatening but can cause various disorders if allowed to continue. For example, sleep deprivation aggravates some forms of mental illness.
The nurse can assist clients to get enough sleep and rest by providing safe, comfortable, and quiet surroundings. Various treatments such as a soothing back rub, warm tub bath, warm milk, and certain medications can also promote sleep.
Activity and Exercise
Activity stimulates both the mind and body. Exercise helps maintain the body’s structural integrity and health by enhancing circulation and respiration. Mobility is not necessary for survival, but some form of exercise is needed to maintain optimum health.
The nurse can assist the client to obtain needed exercise in many ways. Examples include encouraging a person to walk after surgery, teaching a client to walk with crutches, providing passive range of motion, and teaching the person in a cast to do exercises. Clients in nursing homes are encouraged to exercise, even if they are confined to wheelchairs. Physical therapists and nurses work together to assist clients with rehabilitation of injured bones and muscles. The person who is paralyzed from the waist down can do pushups in bed and many other upper body exercises. Turning the immobilized person often helps to prevent lung problems, skin breakdown, circulatory problems, bowel obstruction, and pressure ulcers (bedsores).
Sexual Gratification
Sexual gratification is important; however, unlike other basic physiologic needs, sexual gratification may be sublimated. The need for sex is not vital to the survival of the individual, but it is vital to the survival of the species.
The nurse will need to be aware of sexuality issues when care is given. Perhaps an older male client is not comfortable with a younger male or female nurse. A client may also wish to discuss sexual problems with you. As part of the assessment, the nurse may learn that the client has concerns relating to sexual issues. For example, the client recovering from surgery may be concerned about the physical effects of sexual intercourse on a healing incision. Remember that age or physical disability usually does not eliminate a person’s desire for sexual activity.
Temperature Regulation
Several factors can threaten the body’s need for temperature regulation, including excessive external heat or cold or a high internal fever in response to an infection. The human body functions within a relatively narrow survival range of temperatures. Core temperature survival ranges for the human body (under usual circumstances) are given below using equivalent values from the Celsius and Fahrenheit scales:
35°C to 41°C; “Normal oral temperature” = 37°C
95°F to 106°F; “Normal oral temperature” = 98.6°F
The body has mechanisms to assist in temporary regulation of body temperature. These mechanisms include shivering, goose flesh, and perspiration. The nurse will assist clients to meet the need for temperature regulation in cases such as a severe burn, a high fever, or exposure to extreme heat (heat stroke) or cold (hypothermia, frostbite) by monitoring the client’s temperature and providing treatment for the effects of thermal damage.
FIGURE 5-2 · Security and safety needs can be met by helping the client ambulate using a walker. Notice how the nurse uses her body position and her arms to anticipate helping the client in case of loss of balance.
Security and Safety Needs
The second level of Maslow’s hierarchy of needs relates to safety. At this level, there are both physical and psychological needs (Fig. 5-2).
Freedom from Harm
People must feel safe and secure, both physically and emotionally, before being comfortable enough to move on to meet other needs. They must feel free from harm, danger, and fear. Characteristics of safety include predictability, stability, and familiarity, as well as feeling safe and comfortable and trusting other people. Financial security is also a component of this need.
Safety adaptations are made for age, whether the person is old or very young. The person who is physically challenged often needs special adaptations. The nurse may assist in removing threats to safety from the client’s environment. Examples include using proper handwashing techniques, preventing wound infections by using sterile dressings, using a night light, disabling the gas stove in the home of a person with Alzheimer’s disease, and locking up poisons in the home to safeguard small children. The nurse can explain to clients their surgical procedure before surgery, as well as any other treatments or medications. Such discussion can help clients feel safer and can aid in postoperative recovery.
Key Concept Any type of abuse is a threat to the basic need for safety and security If a person feels unsafe, he or she cannot pursue higher-level needs.
Abuse. Abuse within the home has always existed. Society is becoming less tolerant of all types of domestic abuse. Legal penalties for abuse are becoming more severe. Abuse may take the form of spousal or partner battering, child abuse, or rape by family members or others. Psychological abuse may have longer lasting scars than physical abuse. Often, people find it difficult to escape from abusive situations for many reasons. Resources within the community can assist victims. The nurse is legally bound to report any suspected abuse in the clients. Remember that abuse also can occur in the healthcare facility. Abuse must be reported immediately.
Nursing Alert If you, as a nurse, do not report suspected abuse, you could be subject to arrest and civil penalties.
