Maslow’s general theory of human needs is based on a hierarchy where once the so-called lower level needs are satisfied, those needs being fairly basic and fundamental—then attention turns to more individualized needs that are adapted to each person as opposed to merely placed across the board as standardized interventions categories. Lower order needs represent needs that get a situation under control. This includes fundamental interventions such as ambulance, emergency treatment, hospitalization, IV’s, proper unit placement of the patient in the common event that the patient will indeed need to remain in the hospital. Physiological treatment also consists of follow-up treatment according to prescribed measures that physicians recommend based empirical knowledge and data regarding common response treatments based on empirical knowledge and data regarding types of treatment based on diagnosis which promptly is administered upon check in to the hospital. The needs in ascending order are Physiological, Safety, Belonging and love (social) Deficit or D-needs. These first four needs are also known as D-needs. D needs are distinguished by their absence. If a D need is not present, the patient will feel their absence and yearn for them (Maslow, 1970). When each of their lower level needs are met, the patient reaches what research calls a state of homeostasis where the yearning stops. All of these are survival needs and mostly genetic (Maslow, 1970), i.e. inherited and inevitable. Adaptable high level needs include esteem building and self-actualization. Self-actualization does not involve homeostasis, as because it is not experienced as a gap, but once it is instilled will always remain a feeling. Self-actualization is something that rarely happened to anyone, ill or not, but stands as an appropriate ideal for the nurse to ascribe to (Maslow, 1954). And how does nursing fit in with Maslow’s needs? Due to the fact that the nurse is a healing caregiver, she is entrusted with more than just carrying out the physician’s prescriptions, theories and recommendations. She is further responsible for keeping the patient in a state of mind that is healthy and positive, and is best suited to getting optimal results and the most effective response of the treatment initially prescribed by the physician. The nurse can facilitate recovery through the standardized model of Maslow’ needs hierarchy. One important note is that Maslow in 1970 changed the needs from five to 7, adding two more levels which are not widely used today, but stand as insightful components for the nurse in facilitating a full recovery thereof. The two added components higher up the hierarchy were Know and Understand and Aesthetic (Maslow, 1954). These were informed and enlightened terms, where Know and Understand means the patient had full awareness of their disease as well as the most attractive alternatives for treatment aimed at improving the quality of life they still have, as steps attaining a level of fulfillment that enables the patient to move past recovery into the hustle and bustle of everyday life. If the patient can feel better than they did before, or feel better than they did, or more empowered than before, the nurse is utilizing the appearance and value in the recovery process thereof. Aesthetic refers to levels of fulfillment, where the patient looks and feels and gives off impressions that are concerned with the patient’s sense of self, and are largely dependent on the esteem component lower down on the hierarchical chain.
In the particular context of the hospital environment, there are three modalities or categories of treatment that the nurse is concerned with, and to which she can apply in the representative setting the structural mold of Maslow’s needs hierarchy as a form of recovery.
The first area is geriatrics. The hierarchy is ranked in ascending order, but ranges according to priority. Physiological needs are the most important, obviously, first because they address the physical issues, treating the patient and saving them from suffering, debilitating effects of the condition, or even death. In the case of geriatrics, physiological needs are designed to address the everyday limitations in function that takes place in older people and also slows motor function, which also can affect self-esteem (Acell, 2004). However, for the nurse, the mental process is more relevant, because that’s where she can have the greatest impact, above and beyond the medical treatment thereof.
Safety and security; love, affection and belonging; self-esteem; and self-actualization follow in that order of priority (Application, 2012). Being that these are geriatrics whose aging has limited their physical and motor skills, the first priority is to meet their physiological needs on an ongoing daily basis. However, once these physiological needs are covered, in the environment of the extended care facility, the nurse can effectively build and concentrate on those other areas for geriatrics. Safety and security means showing that through transference they are still cared about and recognized as human beings. Love, affection and belonging is another aspect of transference that refers not only to the fact that someone is caring about them as people such as in the safety and security level, but that now something is taking place within the patient as an individual, not just as old people who need emotional support. The sense of love and affection makes geriatric people feel more relevant to the world and literally more connected to the world and thus more alive, which contribute to a rise self-esteem. If the nurse can go so far as to raise the self-esteem of geriatric patients, then she can have the opportunity to help geriatrics reach self-fulfillment. These populations are past their primes in life, and are dealing with living life on severely limited terms, and if the nurse can help them find their way to self-fulfillment within those parameters.
Pain creates a psychosocial burden that exacerbates the conditions, and the healing capabilities, of cancer patients quite often. The problem with pain, which the nurse needs to know in aproaching the use of Maslow’s hierarchy, is that as research explains that the common system of pain for cancer patient takes on its own meanings, whereby it is a “uniquely personal experience, pain markedly impacts the quality of an individual’s life, increases vulnerability in an already vulnerable population, and engenders dependence on healthcare providers for access to adequate pain management. Cancer pain frequently is assessed and treated inadequately (Cancer pain management, 2012).”
For the nurse, the physiological intervention for pain management of cancer is medical therapy, or both pharmacological and non-pharmacological measures. At this point the oncology nurse in particular embraces holistic care as well as clinical care. The nurse can augment the therapies prescribed by doctors because nurses have a much longer relationship and interaction duration with the oncology patients. Thus nurses can identify undertreated and untreated forms of cancer pain and be advocates for more research and experimentation into those areas. The nurse plays both a care support role and social role in supporting these initiatives of the physical aspect of cancer patient pain management according to Maslow’s hierarchy, so that the nurse is not only facilitating the physician’s prescribed administration of cancer pain therapy, but is also an emerging process due to other knowledge of different types of pain and the steps of pain which she has to lobby for in order to make sure that untreated or undertreated pains do not go unnoticed or undertreated thereof.
As for safety, the nurse should be aware and of the fact that “all people with cancer have a right to optimal pain relief that includes culturally relevant and sensitive pain education, assessment, and management,” and that “the public, people with cancer, and significant others must be educated about the right to relief from cancer pain (Cancer pain management, 2012).” The nurse plays the advocate role in Maslow’s hierarchy all the way up the ladder in the case of oncology pain. By empowering the patient with more knowledge about types of cancer pain, and what to look for, and also by definition the advocacy role that nurse takes when identifying the oncology patient’s pain, the nurse by transference in making the patient feel more comfortable and safe about their treatment, where comprehensive cancer pain management becomes a “multidisciplinary and collaborative effort that must include ongoing individual assessment, planning, intervention, and evaluation of pain and pain relief. Comprehensive pain management addresses physical, psychological, spiritual, and sociocultural effects of unrelieved pain (Cancer pain management, 2012).” Comprehensive pain management also promotes self-esteem through recognizing all people with pain. According to research, the opportunity for self-actualization takes place primarily through the ways in which oncology nurses carry out the “professional obligation to ensure that institutional and clinical standards for cancer pain management are adopted (Cancer pain management, 2012).” Actualization for the cancer pain patient comes from having the pain if not prevented, then fully and effectively treated.
In the terminally ill, the physiological aspect is still a priority, but not of the same nature as in the other examples within the Mid-Gen department. This is because of course there is no cure or treatment for terminally ill patients; there is only the provision of a sense of dignity and meaning in their final days.
Physiologically speaking, the nurse can impact the patient the most through helping the patient through the clinical process of reaction to the news and adaptation to the reality that terminally ill patients will go through. The type of care, be it the palliative that provides comfort, or the hospice resident house that provides programs for preparing themselves physically and mentally to die, is a decision that is the function of the recommendation of the physician and the wishes of the patient, but the nurse can walk them though their options by bringing knowledge about the realities of each of the options that the patient is considering. The first stage is denial, considered the first stage of death and dying where the patient cannot accept the reality of death. This is complemented by other clinically identified progressive emotions and psychological states that the nurse needs to be prepared to handle with the patient, or assist the patient with, including with acceptance, the final stage of death and dying when the patient accepts that they are going to die (Terminal Illness, 2012), and helps them through, with the ultimate goal being the ultimate fulfillment of being ready to die, and accepting one’s fate, and putting one’s affairs in order as best they can.
To achieve safety and security, the nurse must ensure that the patient’s need to be free from anxiety and fear and the need to feel secure in the environment are met. Love and affection is to be derived from the warmth and tenderness that the nurse can provide the terminally ill patient. Self-esteem comes in the form of those dying patients still feeling important and worthwhile, which of course can be helped immensely by that patient’s family members. The nurse can play the advocate role further by advising the family of how much their support is vital to the dying days of their relative, even if the relative knows they are going to die. Self-actualization emanates from the reaching of the full potential the feeling and confidence and full security to meet their maker. In other words, not only making peace with the coming of death, but finding the truth, meaning and even value, as well as the propriety of their death at that moment in time, embracing it fully.
In all these examples, we are reminded of the vital role the nurse plays in caregiving above and beyond the administration of treatment, extending to advocacy and psychological support and spiritual support as well as information.
References
Acello, B. (2004). Nursing Assisting Essentials for Long-Term Care (2nd ed.). New York, NY: Delmar Publications.
Application of Maslow’s Hierarchy of Needs in An Extended Care Facility 2012 http://www.tingmo.com/application-of-maslow%E2%80%99s-hierarchy-of-needs-in-an- extended-care-facility/
Cancer Pain Management (2012) Retrieved May 7, 2012: http://www.ons.org/Publications/Positions/Pain
Daniels, R. (2003). Nursing Fundamentals: Caring and Clinical Decision Making (1st ed.). Clifton, KY: Cengage Delmar Learning.
Rosdahl, C. B., & Kowalski, M. T. (2008). Textbook of Basic Nursing (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
TERMINAL ILLNESS (2012) Retrieved May 7, 2012: http://quizlet.com/185928/human- growth-and-development-flash-cards/
