Course

Maslow's Hierarchy of Needs can be mentally pictured as a pyramid with five levels of differing needs that all humans possess. The bottom layer of this imagined pyramid, also called the foundation, contains the seven basic needs that all humans must fulfill before moving up to the next level. You, the caregiver, have physical needs. In addition, every single one of your residents has basic needs. 

The seven basic needs for all humans can be easily remembered by remembering and using the acronym 'OWN-A-SEX.'  The individual components of the OWN-A-SEX acronym can be located directly below this paragraph.

O: OXYGEN 

W: WATER

N: NUTRITION

A: ACTIVITY

S: SLEEP

E: ELIMINATION

X: SEX

Basic needs all pertain to maintenance and sustenance of the human body and/or the human race. For instance, a patient who is deprived of food and water will eventually die. People of childbearing age who do not have sex are unlikely to have the number of children it takes to keep the human race going. 

'O' stands for oxygen, which represents the basic drive to breathe in order to survive. 'W' stands for water, which represents the hydration that the human body needs in order to survive. 'N' stands for nutrition, also known as the nutrients found in the foods that humans must eat in order to survive. 

'A' stands for activity, representing the movement that the human body needs in order to thrive. 'S' stands for sleep, representing the adequate rest that every human body needs in order for cells to repair themselves and rejuvenate. 'E' stands for elimination, which represents the excretion of urine, stool and carbon dioxide.

'X' stands for sexual intercourse. This particular basic need might confuse some students because a person can live an entire lifetime without sex. Nonetheless, humans must have sexual intercourse in order to reproduce future generations of offspring. In other words, sexual intercourse is a basic need because the human race would eventually become extinct without it.

Why are basic needs important? Our patients cannot focus on higher-level needs until these basic needs have been fulfilled. For example, your hospital patient is not going to want to learn about his discharge instructions until he uses the bathroom. We must help him meet his elimination needs before he can focus on higher level needs such as learning how to apply his brace before he discharges to home. 

Likewise, a caregiver is not really going to do perform optimally at the workplace if she is feeling sluggish, hungry and has not eaten in 48 hours, so she must meet her basic needs for food before she reports to work again. A child who lives in poverty usually performs poorly in school due to unmet basic needs such as hunger, thirst, poor air quality, and inadequate rest from living in crowded conditions.

In the aforementioned examples, the worker cannot focus on higher level needs at the workplace until her hunger subsides, and the poor child cannot focus on higher level needs such as school achievement until his basic needs are met.

Nurses, nursing assistants and caregivers provide assistance to meet the the basic needs of their clients and patients all the time. In fact, many of our patients' call light requests deal with unmet basic needs such as hunger, thirst, urgency to use the restroom, and so forth. 

Additionally, most basic nursing skills address one or more physical needs. For instance, the procedural skill of placing a client onto a bedpan directly pertains to the basic need of elimination since the caregiver is supporting the need to eliminate waste from one's bowel and/or bladder. The skill of feeding a dependent patient is directly related to meeting the basic needs of water and nutrition.

The skill of ambulating a patient with a transfer belt deals with the physical needs of activity and mobilization, and so do the range of motion exercises. Moreover, a nurse or patient care technician who does everything possible to maintain a quiet environment on the hospital unit or nursing home floor at bedtime is meeting the patients' needs for restful sleep.

You will provide assistance to meet the the basic needs of your clients and patients multiple times during each work shift. This is because the fulfillment of basic needs is the foundation of nursing care. Consequently, become accustomed to anticipating the basic needs of your patients. After all, these needs are not going away anytime soon. 

We have previously established that the bottom layer, or base, of the pyramid that represents Maslow's Hierarchy of Needs contains the most basic survival needs such as food, water, air, sleep, elimination and activity. The next layer of the pyramid on Maslow's Hierarchy of Needs contains the needs related to safety and security, which pertain to keeping individuals safe and secure from harm.

This second layer of needs will come into prominence when all of a person's physical needs have been completely met on a consistent, ongoing basis. Persons who currently exist in the safety & security needs layer on Maslow's Hierarchy are fixated on seeking out safe surroundings, protection, freedom from harm, shelter, financial security and stability. Also, people must fulfill these needs before they can effectively focus on attaining higher level needs such as achievement or a sense of belonging.

For instance, a homeless patient's safety and security needs tend to be chronically unmet since he does not have the permanent shelter that would keep him safe from the elements. A domestic violence victim's safety and security needs are unmet since she often feels unsafe at home due to frequent episodes of spousal abuse. 

A coworker who is being bullied at the workplace has unfulfilled safety and security needs since she perceives the threat of potential harm to her personal safety while working. A patient who lives in a neighborhood with an enormously high crime rate also has unmet safety and security needs due to the perception of potential harm to his personal safety while taking leisurely strolls, eating dinner, or engaging in other routine activities near his home.  

A 77-year-old woman who resides with her 50-year-old unemployed daughter has unmet safety and security needs due to the routine occurrences of elder abuse and financial exploitation in their shared household. Furthermore, the elder's 50-year-old daughter has a myriad of unfulfilled security needs due to her unemployment, poverty and resultant financial insecurity.  

In sum, humans need to feel safe from the threat of potential or actual harm before they can address more advanced needs on the Maslow's Hierarchy such as self-esteem, love, belonging, relationships and a sense of community.  

Healthcare workers who deliver direct care regularly take actions to support the safety and security needs of their patients in a number of ways to protect them from harm, preventable injuries, and untimely death. Nurses, nursing assistants, patient care technicians, professional caregivers and other allied healthcare workers who provide direct care keep their patients safe by initiating and observing fall precautions, seizure precautions and aspiration precautions. 

Healthcare staff members also assure and maintain safe environments when they leave their clients' beds in low positions and make sure that the call lights or signaling devices remain within easy reach before leaving the rooms. Medical workers who render direct care keep patients safe and secure by making sure they do not elope or wander away from the hospital or extended care facility whenever they display any signs of confusion or delirium.

Healthcare workers also keep their patients safe and secure by protecting their health and safety through infection prevention measures. Hand-washing is the most effective action a healthcare worker can possibly take to stop the spread of infectious diseases when providing direct patient care tasks. Thus, a nurse or nursing assistant who performs proper hand hygiene before and after patient care tasks is upholding the safety and security needs of his patients.

 Moreover, prompt reporting of changes in condition is an activity that keeps clients safe and often prevents further deterioration in their health statuses. Nursing assistants uphold the safety of their patients when they inform the nurse of changes in condition such as elevated temperatures, new onset confusion, foul-smelling urine, or skin that appears as if it is beginning to break down into a wound. 

When physical needs are totally addressed, humans gravitate toward taking care of their needs for safety and security. Nonetheless, when the safety needs are completely fulfilled, humans naturally progress upward on the Maslow's Hierarchy of Needs pyramid into the love and belonging needs. Love and belonging needs occupy the third and middle layer on the Maslow's Hierarchy of Needs pyramid. 

A patient or caregiver who exists in the love and belonging stage feels the desire for friendships, a romantic partner, possibly children, affection, a sense of belonging, and a sense of feeling as if he or she is a part of the larger community. In a person's daily life, he displays the need for live and belonging through his desire to marry, start a family, be involved in the community, join a church, or participate in extracurricular activities with others (Boeree, 2006). 

In addition, pets such as cats, dogs and birds can provide lonely individuals with a sense of unconditional love and belonging. For instance, a nursing assistant who makes arrangements for an elderly client to see his beloved dog at the assisted living facility is supporting his needs for love and belonging.

Healthcare workers can take deliberate actions that uphold their clients' needs to feel loved and accepted. The nurse who therapeutically touches a patient to demonstrate caring is communicating a sense of love and belonging. The nursing assistant who accompanies a resident to an outpatient appointment is conveying that the resident belongs to a cohesive group and that he is not alone in this world.

Nursing assistants who gather extended care facility residents to bring them to a bingo activity in the dining room are meeting the residents' needs for feeling a sense of belonging to a group that is larger than them. Creating friendly conversation while providing direct care conveys a sense of human connection, thereby upholding the patient's needs for love and belonging.

Self-actualization is the highest-level layer on the Maslow's Hierarchy of Needs pyramid. Once humans have fully met their needs for water, food, shelter, safety, love, belonging and esteem on an ongoing basis, they tend to focus on self-growth, engagement with society as a whole, and transformation into the very best version of themselves.

In other words, self-actualization can be described as a person's deep yearning to accomplish all that he can possibly can and to be the absolute best person he can be. When lower needs such as hunger and lack of shelter are unmet, a person cannot completely devote oneself to fulfilling higher potentials (Boeree, 2006).

Healthcare workers can support patients' needs for self-actualization by helping them learn new material, create ornaments, volunteer, knit blankets, read challenging books, and so forth. When members of medical staff are attentive to patients’ interests and actively assist them in continuing these interests while hospitalized, this fosters a deeper sense of meaning and paves the pursuit toward a self-actualized existence.

To recap, psychologist Abraham Maslow formulated a theory postulating that humans are motivated by five needs, which are arranged on a hierarchical pyramid in layers. The bottom layers are the low level needs such as food, water, safety, security, and belonging. Meanwhile, the higher level needs include self-esteem and self-actualuzation.

Maslow theorized that humans sought to meet the low level first and once this was accomplished, they aimed to satisfy each higher level of need until they have met all five needs (Boeree, 2006). Healthcare workers at all levels of educational attainment and training can take steps to promote their clients' lower and higher level needs throughout the lifespan. These steps function to keep clients safe, secure, free from injury, socially engaged, and feeling valued as a uniquely special human being.

At this point in the course, students should be able to list and describe the five levels of needs according to the Maslow's Hierarchy of Needs Theory. Students should also be able to provide a clear example of ways in which a nursing assistant might be able to assist a patient in meeting his or her needs at each level in an inpatient extended care facility setting. 

Boeree, C. (2006). Abraham Maslow. Retrieved from https://webspace.ship.edu/cgboer/maslow.html

Jennifer, K. (2018). How to Apply Maslow's Hierarchy of Needs to Nursing. Retrieved from https://www.theclassroom.com/how-7727994-apply-maslows-hierarchy-needs-nursing.html