Maslow’s hierarchy of needs

According to Maslow, the most basic level of needs consists of those necessary for physiological survival: food, oxygen, rest, activity, shelter, and sexual expression. These needs are common to all human beings.

The second level of needs is safety and security. These include physical and psychological safety and security needs. Psychological safety and security include having a reasonably predictable environment with which one has some familiarity and relative freedom from fear and chaos.

The third level of needs consists of love and belonging. To a greater or lesser extent, each person needs close, intimate relationships; social relationships; a place in the social structure; and group affiliations.

Next in Maslow’s hierarchy is the need for self-esteem. This includes the need to feel self-worth, self-respect, and self-reliance.

Self-actualization is the highest level of needs. Self-actualized people have realized their maximum potential; they use their talents, skills, and abilities to the fullest extent possible and are true to their own nature. People do not stay in a state of self-actualization but may have “peak experiences” during which they realize self-actualization for some period of time. Maslow believed that many people strive for self-actualization, but few consistently reach that level (Maslow, 1987). He also believed that people are “innately motivated toward psychological growth, self-awareness, and personal freedom. As he saw it, we never outgrow the innate need for self-expression and self-development, no matter how old we are” (Hoffman, 2008, p. 36).

Assumptions about needs

Maslow’s hierarchy is based on several basic assumptions about human needs. One assumption is that basic needs must be at least partially satisfied before higher-order needs can become relevant to the individual. For example, starving people will not be concerned with issues of self-esteem until their hunger is satisfied.

A second assumption about human needs is that individuals meet their needs in different ways. One person may need 8 or 9 hours of sleep to feel rested, whereas another may require only 5 or 6 hours. Each individual’s sleep needs may vary at different stages of life. Older people usually require less sleep than younger people. Individuals also eat different diets in differing quantities and at differing intervals. Some prefer to eat only twice a day, whereas others may snack six or eight times a day to meet their nutritional needs. Sexual energy also varies widely from person to person. The frequency with which normal adults desire sexual activity is determined by a broad range of individual factors.

Although sleep, food, and sex are considered examples of basic human needs, the manner in which these needs are met, as well as the extent to which any one of them is considered a need, varies according to each individual. It is therefore extremely important to determine a person’s perceptions of his or her own needs to be able to provide appropriate, individualized nursing care. If a patient is uncomfortable eating three large meals, such as those served in most hospitals, nurses can help that person by saving parts of the large meals in the refrigerator on the nursing unit and serving them to the patient between regularly scheduled meals. This is a simple example of what is meant by the term individualized nursing care, which recognizes each individual’s unique needs and tailors the plan of nursing care to take that uniqueness into consideration.

Adaptation and human needs

Another aspect of human needs that must be considered is the nature of people to change, grow, and develop. Carl Rogers, a well-known psychologist, built his theory of personhood based on the idea that people are constantly adapting, discovering, and rediscovering themselves. His book On Becoming a Person (Rogers, 1961) is considered a classic in psychological literature. Rogers’ idea that a person’s needs change as the person changes is important for nurses to remember. The human potential to grow and develop can be used by nurses to assist patients to change unhealthy behaviors and to reach the highest level of wellness possible.

The concept of adaptation is also helpful in understanding that people admitted to hospitals and removed from their customary, familiar environments commonly become anxious. Even the most confident person can become fearful when in an uncertain, perhaps threatening, situation. Under these circumstances, nurses have learned to expect people to regress slightly and to become more concerned with basic needs and less focused on the higher needs in Maslow’s hierarchy. A “take-charge” professional person, for example, may become somewhat demanding and self-absorbed when hospitalized. As you will see in Chapter 13, several nursing theorists based their theoretical models on adaptation.

Nuclear and extended families

For most of the history of humankind, immediate and extended families were relatively intact units that lived together or lived within close proximity to one another. In the extended family, children were nurtured by a variety of relatives, as well as by their own parents. This closeness was profoundly affected by industrialization, which fostered urbanization. When families ceased farming, which was a family endeavor, and moved to cities where fathers worked in factories, the first dilution of family influence on children began. The nuclear family (mother and father and their children) moved away from former sources of nurturing, as older relatives such as grandparents, aunts, and uncles often stayed in rural areas.

During World War II, more women began to work, taking them out of the home and away from young children for hours each day. The increased geographic mobility of families since World War II has had a destructive effect on the role of extended family in the lives of children, because nuclear families often live half a continent or more away from grandparents and other family members. The intense attention children traditionally received from adult relatives diminished, sometimes to the detriment of the child’s well-being.

Single-parent families

There are more single-parent families in the United States than ever before, most of which are headed by women. According to the U.S. Census Bureau (2011), as of 2008, 29.5% of all households with children were single-parent households. For comparison, in 1980, 19.5% of households were single-parent households. In 2008, 41% of all births were to unmarried women, a statistic explaining in part the high percentage of single-parent homes in the United States currently. Life is challenging for single parents who must earn a living for the family and fulfill the nurturing roles in the family. Bearing multiple roles alone over long periods of time can be extremely stressful, even exhausting, to single parents.

The examples given here represent only a few of the ways families influence the well-being of individuals. There are many others. A complete nursing assessment includes information about a patient’s family and home environment. This information is particularly important when a modification of the home environment is needed, particularly when a person is returning home with a disability or limitation in their mobility. Importantly, a complete assessment should include screening for intimate partner violence (also known as domestic violence) or, in the case of children, for signs of neglect and abuse. Signs of abuse in both adults and children may not be obvious, and victims often are not forthcoming in the health care setting about their abuser. Abuse and neglect is not uncommon, and careful assessment and the development of a trusting professional relationship may be helpful in helping abused persons share their experience.

Social change

Holmes and Rahe (1967) published a study of the relationship of social change to the subsequent development of illness. They found that people with many social changes that disrupt social support, such as death of a loved one, divorce, job changes, moving, or unemployment, were much more likely to experience illness in the following 12 months than people with few social changes. Both positive and negative changes created the need for social readjustment. In 1995, this study was updated, and the Recent Life Changes Questionnaire (Box 12-2) was devised to reflect more accurately contemporary concerns (Miller and Rahe, 1997). Numerous other researchers have found additional evidence that social support has a direct relationship to health.

Social support

Social support is a commonly used term that is rarely defined. In its largest sense, social support means that a person belongs to a social network, feels loved and cared for, and can count on people for assistance. Social support can be perceived, meaning that individuals recognize that support has been given or is available if needed in the future. Received support refers to the actual helpful (supportive) actions that are offered. Social support works in four ways. Emotional support comes in the form of concern for, affection, love, caring, encouragement, and conveying a sense of value to the person being supported. Companionship is a form of support that gives the supported person a sense of belonging and provides people with whom to share social activities. Informational support is advice and guidance, the sharing of useful information. Material support, also called tangible support, refers to financial help, providing material goods and/or services. Individuals vary in their need and desire for social support. When assessing patients, nurses need to remember that adequacy of social support should be determined by the patient, not by the nurse. For patients who need and desire increased informational support as a form of social support, nurses can be excellent sources of knowledge and direction. Nurses can inform patients about resources for patients and families with specific diagnoses (e.g., cancer support groups, Crohn’s disease support groups, Rare Chromosomal Disorder Support Group), parenting classes, religious groups, bereavement and loss support groups, formal and informal educational groups, and self-help groups. These groups may have local meetings or may have a strong online presence as a means of emotional support, companionship, and tangible support.