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.

Okay, 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 health care 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 nutrition 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 first 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.