Maslow's hierarchy of needs: Clinical decision making

Maslow's hierarchy of needs is a framework for understanding and prioritizing patient care based on ascending levels of human needs.

Using Maslow's hierarchy of needs allows nurses to successfully navigate patient needs within various clinical scenarios, and is essential for providing safe, quality care and improving patient outcomes.

OK, so Maslow's hierarchy of needs organizes a patient's needs by priority, typically illustrated as a five-tier pyramid.

Fundamental needs must be met before higher level needs can be pursued, so fundamental needs are at the pyramid base, while higher level needs are at the top.

So, at the base of the pyramid are physiological needs essential for human life, such as oxygen, fluids, nutrition, body temperature regulation, and elimination.

Once these needs are satisfied, the focus shifts to safety and security needs, including physical and psychological safety.

Physical safety includes the need for comfort and protection from harm, like violence or health threats, while psychological safety involves feeling emotionally secure and stable.

Next up is the need for love and belonging, which refers to having social relationships like friends, family, and other connections, which can include members of the healthcare team.

Moving higher in the pyramid is the need for self-esteem, which encompasses a patient's sense of self-worth and positive self-image, as well as feeling valued and respected by others.

Finally, at the top of the pyramid is self-actualization, which involves reaching one's full potential and achieving personal goals through continuous self-improvement.

Maslow's hierarchy of needs can guide nurses to prioritize interventions for patient care. For instance, when caring for a patient diagnosed with esophageal strictures, the nurse would first address nutritional and hydration needs.

Once these basic needs are met, the nurse can go on to address the patient's fears about their diagnosis and its effects on their personal relationships and self-image.

On the other hand, sometimes a patient's actual needs may not strictly follow Maslow's hierarchy, but should instead be tailored to a patient's unique situation.

For example, when providing end of life care, the nurse may 1st focus on safety and security needs by addressing the psychosocial aspects of pain and anxiety, along with love and belonging needs through the presence of family members before addressing physiological needs like nutrition.

Now let's look at a scenario where a nurse uses Maslow's hierarchy of needs to make clinical decisions and prioritize care.

Nurse Maria is caring for Judy, a newly admitted older adult recovering from a hip fracture sustained during a fall. Nurse Maria enters Judy's room to introduce herself and begin her shift assessment.

While she tests the sensation and strength in Judy's lower legs, nurse Maria asks Judy about her necklace. Judy explains the necklace was a gift from a piano student she taught prior to her retirement.

She tearfully states she misses being at home and wishes she was there so she could play her piano. Next, nurse Maria asks about pain, which Judy rates at a 7 out of 10 and describes as aching around her hip.

Nurse Maria notices that Judy grimaces when she moves, and she also notes that Judy is barefoot. She then reviews the electronic health record, or EHR and sees that Judy's participation in physical therapy was limited due to pain, and that her last pain medication was administered 5 hours ago.

Nurse Maria uses Maslow's hierarchy of needs to analyze the clinical data she's gathered and prioritize care. First, nurse Maria addresses Judy's safety and security needs for comfort by managing her pain.

She administers her prescribed analgesic following safe medication administration principles, and explains to Judy that she'll offer her pain medication every 4 hours to help keep her pain within a tolerable level, which Judy says is a 3 on a 0 to 10 scale.

Nurse Maria also applies an ice pack to Judy's hip and repositions her for comfort. Next, she further addresses Judy's additional safety and security needs to reduce the risk of falling by placing non-skid socks on Judy's feet, ensuring the bed is in its lowest position, and that the bed alarm is turned on.

She also places the call bell within reach and advises her to use it if she needs help getting out of bed. One hour later, nurse Maria reassesses Judy's pain, which she reports is 2 out of 10.

With Judy's pain now under control, Nurse Maria addresses Judy's self-esteem needs. She informs Judy that there's a grand piano in the lobby of the facility.

After seeing Judy's excited reaction, she asks Judy if she would like to travel by wheelchair to see it. Judy eagerly agrees.

Next, nurse Maria and the unlicensed assistive personnel help transfer Judy to the wheelchair and transport her to the piano.

Upon arriving, they position Judy at the piano keys, where she's able to play a song. After the song ends, several visitors approach Judy to compliment her talent.

During the return trip to her room, Judy expresses that playing the piano reminded her of home and helped her feel more like herself.

Once Judy is settled back in bed, nurse Maria reflects on Judy's care and evaluates her actions. She determined that Judy's safety and self-esteem needs were successfully prioritized and addressed.

She'll continue to monitor Judy and prioritize care according to Maslow's hierarchy of needs. All right, as a quick recap.

Maslow's hierarchy of needs is a framework for understanding and prioritizing patient care based on ascending levels of human needs.

It's structured as a five-tier pyramid where fundamental needs must be fulfilled before attaining higher level needs. From bottom to top, the pyramid includes physiological needs, safety and security, love and belonging, self-esteem, and self-actualization.

Using Maslow's hierarchy of needs allows nurses to successfully navigate patient needs within various clinical scenarios, and is essential for providing safe, quality care and improving patient outcomes.