Nursing practice and Maslow’s hierarchy of needs

In 1943, a young psychology professor at New York’s Brooklyn College published a paper in the prestigious academic journal, Psychological Re...

Nursing practice and Maslow’s hierarchy of needsIn 1943, a young psychology professor at New York’s Brooklyn College published a paper in the prestigious academic journal, Psychological Review. Entitled “A Theory of Human Motivation”, it was to have an immense impact not only in the field of psychology but in social sciences, education, healthcare and the wider culture. 


The young academic was Dr. Abraham Maslow, whose name is still associated with his evocative thesis – that humans have an innate ‘hierarchy of needs’, ranging from the most elemental (the physiological need for nutrition) to the spiritual, which he referred to as “self-actualization.” Each one of the needs he outlined must be satisfactorily met before an individual is equipped to progress through the subsequent phases of the hierarchy and flourish to their fullest potential.


Maslow’s thesis has proven enormously versatile since it was published. In a recent article for Forbes, for example, HR executive Ruchi Kulhari shows how organizations can draw from it to inform their management of (and support for) employees as they progress through their careers.


In simplified form, the hierarchy consists of five levels. It is often depicted graphically as a tiered pyramid with the most basic needs at the base and the most advanced at the apex. These needs, in ascending order, are:



  • Level 1: At the most basic, humans will perish unless they receive sufficient provisions of nutrients (food) for vital physiological functioning. 



  • Level 2: With that provided, humans also need ongoing shelter from danger and chaos, a place of safety and security to inhabit. While, like most of these levels, the need continues throughout life, it’s especially important in infancy and childhood, during which its provision lays the foundations for personal-psychological security and the ability to make secure affectionate attachments with others.   



  • Level 3: Moving to emotional-psychological and social needs, Maslow believed that humans have an innate need for love and belonging. In infancy and childhood, this is predominantly provided within the family. As people mature, the provisions come from wider social groups and networks (which in the age of digitally simulated ‘social’ media, have spawned higher levels of anxiety as well as connectedness). 



  • Level 4: From this essential social-emotional “nutrition”, humans thrive when they are able to fashion positive self-esteem



  • Level 5: With the four preceding needs adequately met, humans are able to progress to the fulfilling but open-ended task of self-actualization – living in such a way that one’s talents are constantly developed and made real through continuing engagement with the real world.


Let’s explore how Maslow’s hierarchy can be applied in the nursing profession.


Maslow’s hierarchy of needs for nurses


By ensuring the provision of these fundamental developmental needs for patients receiving nursing care, improved outcomes are facilitated through a more empathic and holistic model of nursing practice. 


Optimally, Maslow’s hierarchy and its application to patient care are best learned by student nurses during their training. For that reason, it’s wise to choose a high-quality accredited nursing program. Today, new fast-track entry qualifications to the profession are becoming available – notably, the Accelerated Bachelor of Science in Nursing (ABSN). Well-established, traditional brick-and-mortar centers of higher education excellence, like Texas’ Baylor University, are now offering an online ABSN. Provided applicants already possess a Bachelor’s degree in a different subject area, this can be completed within one year. A conventional BSN, by comparison, usually takes four years, 


Let’s turn to a few clinical scenarios to illustrate the relevance and value of Maslow’s hierarchy to nursing practice.


Patients’ physiological needs: Like everyone else, patients continue to need sufficient food and water/fluids to keep their basic physiological systems functioning. But nurses do a little more: they actively monitor patients’ physiological functioning during an episode of care, ensuring that cardiovascular, respiratory and digestive systems are working as they should throughout – and intervening where necessary if they don’t. If upon reading a patient’s vitals, a nurse discovers breathing difficulties, for example, the priority becomes working with a doctor to help that patient receive more oxygen and become more comfortable.


Patients’ needs for safety and security: With physiologically needs carefully monitored and stabilized where necessary, patients also need to feel confident that they are in “safe” (competent and compassionate) hands during, say, an in-patient stay. Simple provisions like ensuring that good safety precautions are in place (such as railings on their bed to protect them from falling) will help cater for physical safety. Attentive listening and checking on patients' comfort levels will help provide emotional safety. 


Patients’ need for love and belonging: Although this is related to the preceding level, the need for love and belonging (especially important for patients who may be anxious about an illness or injury)  can be symbolized potently by nurses through building ‘caring trust’ with them – inquiring kindly about their life beyond the hospital, their interests, whether they have family members nearby and so on.


Patients’ need for self-esteem: The most effective nurses see patients as persons, not illnesses or conditions. Ms. Shaw is in bed four, not an “appendectomy” or a fractured collarbone. Speaking and tending to patients as persons like oneself shows both care and respect, which in turn conveys the message that patients are deserving of such ministrations. This can also be demonstrated by taking an interest in patients’ post-hospitalization wellbeing by engaging in conversations and offering suggestions for improving their health. On the ward, nurses who celebrate a patient's achievement in accomplishing a goal, like being able to take a few steps unassisted after a surgical procedure, convey the same message – that you are worthy of care and respect.


Patients’ needs for self-actualization: Maslow held that people can only self-actualize once the preceding needs in the hierarchy have been sufficiently met. At this point, people feel able to explore options for personal growth and real-izing (making real or actual) their fullest potential, which is perhaps an endless, though inherently fulfilling, process. An example would be reminding a patient when compiling his or her discharge paperwork how far they’ve progressed and how they can continue to outface challenges and grow from them.


Conclusion


Being aware of all of the levels of Maslow’s hierarchy and how they apply to each patient makes for nursing care that is not only competent but also compassionate and encouraging. Professor Maslow might not have imagined it when he penned his original paper in 1943, but he has left a lasting impression on all who encounter his work – nurses included.

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