Healthcare
Consider higher-level coping skills in relationship to planned versus unplanned healthcare. People who are living in poverty, who are starving or homeless, or who feel unsafe are unable to plan ahead for healthcare. In addition, some people are disabled by mental illness or chronic abuse of drugs. In most cases, people in these situations become ill first and then seek healthcare. Such behaviors are concrete methods of dealing with illness, or emergency responses to the stimulus of illness (episodic healthcare). People in developing countries often have no access at all to healthcare. Their healthcare needs are unmet, thus shortening their life expectancy.
People in more comfortable situations are able to strive for wellness and prevention of illness.They experience a more abstract means of coping and of seeking healthcare. Abstract thinking and action require higher-level skills, including planning and being able to understand the consequences of being unprepared.
Shelter
The lack of adequate shelter may not always be life threatening but will thwart the ability of a person to progress toward a higher level of needs. A person’s shelter should provide the warmth necessary to maintain an adequate body temperature, in addition to helping the person feel safe.
A large number of Americans are homeless, including significant numbers of children. Often, healthcare providers are unaware that a client is homeless. Be alert when interviewing clients; a comprehensive evaluation is often needed to uncover this situation because the person may be embarrassed or ashamed.
The homeless person with children to care for faces great problems. Such individuals not only must find food and shelter for themselves, but for their children as well. Safety is an issue, because it is more difficult to protect themselves and their children at the same time. The children lack a sense of security because they do not know where they belong and often do not understand what is happening.
The homeless spend most of their energy trying to cope with daily life. They may travel great distances by foot to locate food and other necessities. They face the constant dangers of disease, frostbite, or physical harm from others. They often must move from place to place, sometimes to avoid the law or to fulfill time limits in shelters. Many homeless people carry all their belongings with them to avoid theft. With all of these contributing factors, these individuals have little emotional energy left to worry about meaningful relationships, belonging to a group, maintaining cleanliness, or going to school. No time exists to be creative. Finding a permanent job without an address or telephone is almost impossible, adding to despair and hopelessness. These people are often mired at the lower levels of the basic needs hierarchy.
Healthcare for the homeless is a problem that many communities are addressing. Some community health and public agencies have nursing services that provide outreach, health assessment, and health monitoring programs for individuals and families. For example, screening these individuals for tuberculosis and other communicable diseases and giving immunizations to the children are important to the individual as well as to the health of the public.
Love, Affection, and Belonging
Societal Needs
Social needs are addressed in the third level of Maslow’s hierarchy. The needs for love, affection, and belonging are fundamental human needs; however, people must meet survival and security needs before they can address social needs. Love and affection begin with bonding between the infant and mother at birth and must continue throughout life for a person to meet needs at this level. All people need to feel that they have meaningful relationships with others and that they belong to a group. People need the acceptance of their families and friends. Gang affiliation is one method of meeting the need to belong. The elderly person and the young person in society often have much in common in that they may not feel a part of a group. They may feel that they are not useful or appreciated. Encouragement and assurance from loved ones can help to alleviate such anxieties.
When an ill or injured person is in a healthcare facility, he or she is often separated from friends and family. The person who is confined to home may also lack social contacts. Many people are very frightened and do not feel safe, especially when they are ill. The nurse can assist these people by encouraging visitors, cards, and telephone calls, and by visiting with the client whenever possible. Explain to the client’s family that the person needs more reassurance and acceptance if he or she is disfigured or disabled in any way. Clients being cared for at home need social support, stimulation, and encouragement from nurses and their loved ones. Do not forget the universal need for diversion, recreation, and social interactions.
Key Concept A need at any given level of the hierarchy is more urgent to the person if the needs below it are satisfied. Thus, a person who is not preoccupied with obtaining oxygen and finding food will be able to be concerned with love and belonging.
Spiritual Needs
Many people believe in a higher power. This power takes many different forms, depending on one’s religious background, ethnicity, and life experiences. The person who is ill or injured may find comfort in spirituality. The nurse can help clients to meet their spiritual needs by assisting them to worship services, by providing reading or video materials, or by contacting the client’s clergy person or the chaplain of the healthcare facility.
Self-Esteem Needs
The term self-esteem (self-image, self-respect) is related to the person’s perception of self. Positive self-esteem is an appreciation of one’s own personal worth. A person who feels that his or her contributions are appreciated by family, friends, employers, for example, is more likely to have selfconfidence. People meet their esteem needs when they think well of themselves by considering individual achievements, perception of self-adequacy, or self-competence. Selfesteem is related to how an individual is thought of by others through recognition, status, awards, or prestige.
Those who are ill or injured or who undergo surgery may have altered levels of self-esteem. This scenario is often true in situations that change a client’s appearance and lifestyle, such as amputation of a limb or the presence of scars or acne. Many women experience difficulty with their selfimage after a hysterectomy or breast removal. As a nurse, you will be able to assist such individuals to regain positive self-esteem by encouraging independence, by rewarding progress, and by allowing them to perform as much self-care as possible. Observe these clients for symptoms of regression, depression, overdependency, or a refusal to cooperate. Low self-esteem also directly relates to disorders such as chemical dependency. See Box 5-1 for examples of nursing interventions throughout the hierarchy of needs.
Key Concept There is danger that the needs of the nurse can influence the level of nursing care. Be careful not to let this endanger your client!
Self-Actualization Needs
The self-actualized person has “reached his or her full potential.” Thus, needs at this level are the highest-order needs. The self-actualized person is comfortable enough to plan ahead and to be creative. Great artists and musicians are often functioning in the self-actualized sphere. The person incorporates all levels to function as a self-actualized person. As with other levels of Maslow’s hierarchy, lower-level needs must first be satisfied before the person can work at self-actualization. Remember that people can function partially on this level, even though all other needs have not been met. Those who are comfortable with themselves and their place in the world have the emotional energy to plan, to learn, and to create.
The term self-actualized implies a fully functioning person. Maslow described this state as a “more comfortable relationship with reality.” The self-actualized person is able to cope with life’s situations, to deal with failure, and to be free of anxiety. This person has a sense of humor, is self-controlled, and is able to deal with stress in productive ways. Self-actualization can take the form of being a better person, obtaining an education, being a good parent, or learning to grow roses.
Many psychologists believe that people reach this level many times throughout life, yet very few people believe they have reached the peak of self-actualization permanently.
BOX 5-1. Hierarchy of Needs and Nursing Interventions
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Nursing actions and Maslow’s hierarchy can take many forms. This box gives examples of nursing interventions that can assist a client to meet basic and aesthetic human needs. The hierarchy begins at the bottom and works upward. |
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Self-Actualization |
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♦ Acknowledging the accomplishments of the individual |
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Self-Esteem |
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♦ Promoting positive self-image after surgery ♦ Encouraging an individual’s progress in rehabilitation ♦ Providing an opportunity for bonding with a new infant |
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Love, Affection, and Belonging |
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♦ Allowing the client’s family to visit while in the hospital ♦ Encouraging the family to participate in the care of the client ♦ Allowing religious leaders and friends to visit and perform religious rites ♦ Being sensitive to a client’s particular needs as they relate to his or her role in society (e.g., financial provider or caretaker of others) |
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Security and Safety |
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♦ Checking identification of client before administering medication ♦ Taking defective equipment from a client’s environment and reporting the defect ♦ Monitoring the client’s safety while in the shower, ambulating in the hall, or getting in or out of bed ♦ Performing a safety check in the home environment for a child or an elderly adult ♦ Reporting abuse to the proper authority |
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Basic Physiologic Needs |
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♦ Administering oxygen ♦ Assisting with feeding a client ♦ Assisting with hygiene and elimination ♦ Maintaining warmth for a newborn |
An individual who has met his or her highest goal is most likely to continue to create new personal or professional goals. Thus, the process of becoming self-actualized continually flows as new goals are born, develop, and are achieved. As a nursing student, you are striving toward selfactualization as well, and you will continue to strive toward new achievements as your career develops (Fig. 5-3).
While in your nursing program, you would be wise to think about Maslow’s hierarchy of needs. You will do much better in your nursing program if you do not have to worry about where you will live, whether or not you and your children are safe, or if you have enough money for food. Basic needs must be met first. When these primary needs are met, then the individual will have physical and psychological energy to reach the higher levels of the pyramid.
FIGURE 5-3 · One way of achieving self-esteem is by having good working relationships with your peers. Self-actualization needs can be met by being successful in personal endeavors. Self-actualization can be reflected by presenting a professional appearance and working comfortably in team environments. Notice here the professional dress of these team members and their body language suggesting mutual cooperation.
Key Concept Homelessness is a threat to the person’s basic need for warmth, shelter and safety If a person is responsible for others, such as children, the threats multiply The higher needs of self-esteem or aesthetics cannot be addressed at all.
FAMILY AND COMMUNITY NEEDS
The family unit has needs that must be met for life to run smoothly. The special needs of the family include developmental tasks and functions to meet the needs of its members. The highly functioning family also works toward common goals as a group.Needs are met in a variety of family structures.
The community has basic needs concerning the welfare of all its residents. Among these needs are public health measures (such as immunization programs), access to healthcare, maintenance services (such as water and electricity), environmental concerns (pollution), safety (police and highways), and emergency services (ambulances and paramedics).
KEY POINTS
• Physiologic needs drive all human beings and animals.
• Human needs are thought of in progressive levels, known as a hierarchy.
• Psychological needs are at a higher level than physiologic needs.
• A person must meet lower-level needs before he or she can address higher-level needs.
• Illness or injury can interfere with a person’s ability to meet basic needs.
• Illness or injury can also cause a person to regress to a lower level of functioning.
• Nursing can assist a person to meet needs or to eliminate potential threats to need satisfaction.
• Many factors, such as loss of income, illness, homelessness, and personal crises threaten basic human needs.
• Health is a continually fluctuating and fluid state of physiologic and psychological well-being.
• Relationships with others, including family and the community, are higher-level needs that can be addressed only after basic physiologic needs are met.
