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A theory that nurses can use to understand the relationship among basic human needs when providing care. The hierarchy of human needs arranges the basic needs in five levels of priority: Physiological, Safety & Security, Love & Belonging, Esteem & Self-Esteem, and Self-actualization.
Have the highest priority in Maslow’s hierarchy. An individual who has several unmet, needs generally seeks first to fulfill physiological needs. O2, Fluids, Nutrition, Temperature, Elimination, Shelter, Rest and Sex are human physiological needs.
The body can function normally within only a narrow temperature range – 37 degrees Centigrade (+/- 1 degree). Also recorded as 98.6 degrees Farenheit. Body temperatures outside this range can result in injuries, permanent effects such as brain damage, or death.
Although most people have some kind of shelter, sometimes it is substandard and does not offer full protection. Disasters such as floods, tsunamis, fire, hurricanes, tornados, earthquakes, and avalanches can render an entire community homeless.
Every person has a basic physiological need for regular rest. The amount of sleep needed varies, depending on the person’s quality of sleep, health status, activity patterns, lifestyle, and age. Patients with chronic disease require more rest than a healthy person of the same age.
Sex is considered by Maslow (1970) to be a basic physiological need that generally takes priority over higher-level needs. Sexual needs and the manner in which they are met are influenced by age, sociocultural background, ethics, value, self-esteem, and level of wellness.
An infant enters the world totally dependent on others for needs and physical safety. As the infant grows and develops, greater independence is gradually achieved. Adults are generally able to provide for their physical safety, but the ill and handicapped may need help.
To be safe & secure psychologically, a person must understand what to expect from others, including family members & health care professionals (including procedures & experiences). Everyone feels some threat to psychological safety with new & unfamiliar experiences.
The next priority after physiological and safety needs is the need for love & belonging. People generally need to feel that they are loved by their family and that they are accepted by peers and the community. Only after individuals feel safe & secure do they have the time & energy to seek love & belonging & to share that love with others.
People need a stable sense of self-esteem, as well as the feeling that they are held in regard by others. The need for self-esteem is linked to the desire for strength, achievement, adequacy, competence, confidence, & independence. People also need recognition or appreciation from others.
When esteem & self-esteem needs are both met, a person feels self-confident and useful. If needs for self-esteem and esteem of others are unfulfilled, a person may feel helpless and inferior.
NEED FOR SELF-ACTUALIZATION – MASLOW’S 5 TH TIER
The highest level of human needs. Theoretically, when people have met all of the lower level needs, it is by self-actualization that they achieve their fullest potential. Self-actualized people have a mature, multidimensional personality. They are able to assume & complete multiple tasks, & they achieve fulfillment from the pleasure of a job well done. They do not depend on opinions of others, and handle their doubts realistically.
In all cases an emergency physiological need takes precedence over a higher level need. With one client the need for self-esteem may be a higher priority than a long-term nutritional need, whereas for another client, this may be reversed.
To provide the most effective care, the nurse must understand relationships among different needs for the individual. Furthermore, although the hierarchy of needs suggests that one need should be met before another, nursing care often addresses two or more at the same time. The nurse provides care for clients with many needs because illness often disrupts the ability to meet needs on different levels.
Enjoy being with other people (trust, respect others, respect diversity, give/receive love)
Enjoy being alone ( Self-respect/confidence, Recognizes assets/short comings, Can laugh at self, derives satisfaction from simple pleasures)
Able to meet demands of life (Sets realistic goals, Makes own decisions, Responsible for self/choices, Welcomes new experiences/adaptable, Realizes everyone meets disappointment and have stress & problems and handles this with honest emotion.
MENTAL AND EMOTIONAL STATUS: A great deal can be learned about mental capacities and emotional state by simply interacting with a patient. To ensure an objective assessment the nurse considers the patient’s cultural & educational background, values, beliefs, & previous experiences.
BEHAVIOR AND APPEARANCE: Behavior, moods, hygiene, grooming, and choice of dress reveal pertinent information about mental status. The nurse must be perceptive of mannerisms & actions during the entire physical assessment. The nurse notes non-verbal as well as verbal behavior.
LANGUAGE: The ability of an individual to understand spoken or written words and to express their self through writing, words, or gestures is a function of the cerebral cortex. The nurse assesses the client’s voice inflection, tone, and manner of speech.
INTELLECTUAL FUNCTION: Intellectual function includes memory (recent, immediate, and past). Knowledge, abstract thinking, association, and judgment. However, because cultural and educational background influence the ability to respond to test questions, the nurse should not ask questions related to concepts or ideas with which the client is unfamiliar.
KNOWLEDGE: The nurse can assess knowledge by asking clients what they know about their illnesses or the reason for seeking health care. By assessing knowledge the nurse determines client’s abilities to learn or understand.
ABSTRACT THINKING: Interpreting abstract ideas or concepts reflects the capacity for abstract thinking. A higher level of intellectual functioning is required for an individual to explain complex ideas. The nurse notes whether the client’s explanations are relevant.
JUDGMENT: Judgment requires a comparison and evaluation of facts and ideas to understand their relationships and to form appropriate conclusions. The nurse attempts to measure the pt’s ability to make logical decisions. By assessing judgment the nurse also measures the pt’s ability to organize thought processes.
SENSORY FUNCTION: The sensory pathways of the central nervous system conduct sensations of pain, temperature, position, vibration, & crude & finely localized touch. Different nerve pathways relay the sensations. For most clients a quick screening of sensory function is sufficient unless there are symptoms of reduced sensation, motor impairment, or paralysis.
MOTOR FUNCTION: An assessment of motor function includes the same measurements made during the musculoskeletal examination. The cerebellum coordinates muscular activity to producing smooth, steady, and efficient movements of muscle groups. The maintenance of balance & equilibrium is also a function of the cerebellum.
COORDINATION AND BALANCE: The nurse observes smoothness and balance of movements.
REFLEXES: Eliciting reflex reactions allows the nurse to assess the integrity of sensory & motor pathways of the reflex arc & specific spinal cord segments. Assessment of reflexes does not determine higher neural center functioning.
Freud divided the growth/development of the human into 5 stages from birth to adulthood: (1) Oral – up to1 yr , (2) Anal-Expulsive – 1-3 yrs, (3) Phallic – 4-6 yrs,(4) Latent – 7-12 yrs, and (5) Genital – 12 yrs onward.
Erikson compares the evolution of the personality to the evolution of tissues in the early stages of embryonic development. There is a timetable inherent in the development of various specialized tissues, organs, & systems in the physical body. During each stage there is a DEVELOPMENTAL TASK accomplished which lays the groundwork for the next stage.
A critical maturational phenomenon related to change, conflict, & perceived control of the environment. Anxiety is a vague & unpleasant feeling that produces many somatic effects or physical sensations in the body: tenseness, tremors, cardiovascular excitation, GI tightening, restlessness. It causes feelings of apprehension, helplessness & general distress.
When a person is anxious, they may not be able to identify the focus or reason for the emotional distress. Until the cause of anxiety is identified, the feeling will continue as an unspecific and unpleasant physical and mental state.
The way the mind responds to awarenesses that are challenging or threatening. It is important to be aware that an event perceived as threatening by one person may be a challenge to another, and be perceived by a third person as quite normal. Because of the varying subjective experiences of stress, coping responses are also uniquely different.
Stress is a word in common use today. The word stress is used in 2 ways. The first refers to the subjective feeling of tension experienced in the physiologic, intellectual & emotional realms as a response to environmental events that are perceived as threatening. The second refers to those environmental events that result in internal feelings of stress.
Stress is any situation in which a non-specific demand requires an individual to respond or take action. It involves physiological & psychological responses. It can threaten emotional well-being, how a person perceives reality, solves problems, thinks and a person’s relationships and sense of belonging.
Stimuli preceding or precipitating change are called STRESSORS. Stressors represent an unmet need & may be physiological, psychological, social, environmental, developmental, spiritual, or cultural. Stressors can generally be classified as internal or external.
PHYSIOLOGICAL ADAPTATION to stress is the body’s ability to maintain a state of relative balance. It is a dynamic form of equilibrium in the body’s internal environment. The internal environment constantly changes, and the body’s adaptive mechanisms continually function to adjust to these changes and thus to maintain equilibrium or homeostasis.
Maintained by physiological mechanisms that control body functions & monitor body organs. These are mostly controlled by the nervous & endocrine systems & do not involve conscious behavior. The body makes adjustments in heart rate, respiratory rate, blood pressure, temperature, fluid & electrolyte balance, hormone secretions, and level of consciousness – all directed at maintaining adaptation.
MAINTAINING GOOD MENTAL HEALTH – BROAD CATEGORIES
(3) Life style changes
MAINTAINING GOOD MENTAL HEALTH – SPECIFIC IDEAS