The concept of a human needs framework has been developed over several decades. Perhaps the most famous version dates back to Abraham Maslow’s work published in 1943 and 1954 in which he describes his motivational theory, the Hierarchy of Human Needs. In Maslow’s hierarchy, there are five key levels of needs:
- Physiological needs: Breathing, fluids, food, shelter, sleep, clothing, reproduction
- Safety needs: Personal security, employment, psychological security
- Love and belonging: Friendship, intimacy, family, sense of involvement
- Esteem: Respect, self-esteem, status, recognition, strength, freedom
- Self-actualization: A desire to become the best that you can be
These needs are illustrated in a pyramid hierarchy, starting with Physiological needs at the base, and rising through Safety, Love, and Esteem, with Self-actualization at the top of the pyramid.
When it was first published, Maslow held the belief that individuals would need their lower-level needs to be fully met before they could seek to meet their higher-level needs. However, he later revised this view, clarifying that people could indeed progress further up the hierarchy without their lower-level needs being met completely.
The first four levels of needs are referred to as deficiency needs. Once the needs for a level have been largely met and there is no longer a deficit for that level, an individual will naturally move to strive for the next level of needs. Self-actualization is defined as a growing need and not a deficiency need. It comes from a wish to grow and develop as a person.
How does the Hierarchy of Needs Affect Nurses and their Work?
Maslow’s theory can be used to shape how nurses provide care to their patients. When patients’ lower-level needs are met, they will feel cared for and are more likely to work toward fulfilling higher-level needs and developing a healthy lifestyle.
Physiological needs are the most basic of human needs. Nurses will not always be directly responsible for meeting all basic Physiological needs, but the fulfillment of these and Safety needs are the foundations for good health. In nursing terms, meeting these needs could involve ensuring that adequate food and fluids are provided to patients, and referring problems relating to accommodation to the relevant department. If the patient is at home rather than in a hospital setting, it may be a case of discussing nutritional and accommodation issues with family members. Without these basic needs being taken care of, patients will not be able to progress to focusing on the higher-level needs that can support recovery and long-term good health.
Supporting Human Needs Through Nursing
Choosing a career in nursing gives you the opportunity to support people in meeting their needs. Anyone who requires medical support from nurses will have unmet human needs of some type. Some patients will have just one or two needs that must be taken care of, while others may have more challenging issues or circumstances that have created a bigger needs gap. An online accelerated BSN from Baylor University can be completed in just one year and will give you the qualification you need to help patients from a highly respected school.
Identifying Patients’ Needs
With some elements of the framework of the need, it may be obvious when a need is not being met, while other gaps in fulfillment may be more challenging to identify. Nurses may need to look below the surface for clues to how patients are feeling. This may involve interpreting non-verbal gestures and another body language, in addition to assessing personal circumstances.
For example, if patients display defensive behavior, this is likely to reflect that their need for Safety is not being met and they are feeling insecure. Body language such as crossed arms could be a sign of defensive behavior. As a nurse, you can respond by trying to counteract the feeling. If it is not immediately clear why the patient is feeling insecure, start by getting to the bottom of what is causing their concern. It could be that the patient feels physically unsafe. If this is the case and there are real risks to the patient’s safety, a nurse or other medical professional will need to address the issue or refer the case to someone who can help. Safety is a basic need for good health.
Alternatively, it could relate to psychological safety needs, such as a fear of what is going to happen with their hospital treatment. If the patient is feeling unsafe because of uncertainty about forthcoming procedures, a nurse can often alleviate these feelings by explaining to the patient exactly what will happen and when. When patients know what to expect, they start to feel more in control and less insecure. Spending time supporting the patient in this way can also help to meet needs at the Love and Belonging level of the framework of the need.
Nurses are not expected to meet all patient needs. They can only be responsible for elements within their control. However, they may be able to help with the fulfillment of further needs by arranging or encouraging support from other people, whether they are other medical professionals, family members, friends, or carers. The setting will affect the extent to which healthcare providers are responsible for needs being met. For example, patients in residential care may need more support from professionals than people who are at home and have the support of loved ones around them.
Some needs can be met by nurses with very little additional effort. For example, when patients start to share details of their lives with you, it is usually an indication that they are looking for love and belonging needs to be met. Showing interest and empathy with active listening skills creates an opportunity to bond with them and make them feel cared for.
Providing patients with support for meeting their lower-level needs encourages them to actively fulfill those needs for themselves over time. For example, a patient who has suffered injuries in an accident may become dependent on others during rehabilitation. It is important that the support required is given when needed, but the patient needs to be gradually encouraged to start doing things for themselves since independence is an important factor in meeting the Self-esteem need.
As the patient becomes more self-sufficient, it will boost their self-esteem, filling another vital need higher up in the framework. This puts people in a position to work on their highest need, self-actualization, where they realize their full potential with personal growth.
