Maslow's Hierarchy of Needs in Nursing Theory and Practice

Introduction to Borrowed Theories in Nursing

In the pantheon of nursing theories, borrowed theories are those that derive from other disciplines and have been adapted to the nursing context. Many such borrowed theories come from the social sciences — such as psychology or sociology — because they directly reflect critical issues in care, including human nature and the role of human interaction in well-being. One could apply religious theories to the care of religious patients, and it is even possible to consider motivational theories when a nurse is trying to encourage a patient to change behavior as a means of improving health outcomes. Borrowed theories have perhaps received less study than either grand theories or mid-level theories, but they are nevertheless an important source of insight for the nursing educator.

It is important to understand a borrowed theory, where it comes from, and how it has been adapted to apply specifically to the nursing context. There is still debate within the nursing community about the usefulness of borrowed theories, because they may not adapt perfectly to nursing practice (Villarruel et al., 2001). That tension is precisely what makes them interesting — they are in common use yet may not be perfectly applicable. For the nursing educator, this matters because choosing what to teach requires understanding the nature of borrowed theories and their pros and cons alike.

Maslow's Hierarchy of Needs: Origins and Structure

Maslow's hierarchy of needs derives from psychology and was developed in the 1950s by Abraham Maslow. This theory outlines five different strata of human needs and proposes that they exist in hierarchical form. It has been widely applied in many fields where human motivation is studied, becoming important not only in psychology but also in the human resources curricula of business schools and, of course, in nursing education (McLeod, 2014). The five strata of needs are, in ascending order: physiological, safety, social, esteem, and self-actualization.

At the heart of the theory is the proposition that lower-order needs must be satisfied before a person can progress to higher-order needs. People who are hungry cannot attend to their social lives until they have acquired food and shelter. Only after those basic needs are met can they focus on social concerns. While exceptions exist — the starving artist archetype pursues self-actualization at the expense of basic physiological need — most people follow this progression. Over the years, Maslow's hierarchy has been subject to scrutiny, but its simplicity and broad applicability have allowed it to remain common in education and practical use across many disciplines.

Abraham Maslow sought to study the characteristics of successful people and what motivated them. His approach was both typical of the era and unconventional. Typical in that early twentieth-century psychology relied little on formal scientific method — he developed his theory more through observation and quasi-academic study than rigorous experimentation. Unconventional in that most psychological study of the time focused on the mentally ill, whereas Maslow was interested in learning how to help people succeed. His hierarchy was published in book form in 1954, and he spent the remainder of his career refining and defending it.

Key Components of the Hierarchy

The key components of Maslow's hierarchy are the five types of needs. Although people have all of these needs simultaneously, the hierarchical element holds that most people prefer to satisfy basic needs first and then progress upward. Self-actualization, for example, is considered a higher-order concern available only to those who have already satisfied the other needs. The hierarchical structure in particular has been criticized for reflecting an individualistic cultural perspective in which self-actualization is prioritized over the social group. A counterargument is that people from cultures where social needs are primary simply stop at that level and do not pursue higher-order needs. Even within those cultures, individuals such as artists tend to place esteem and actualization needs above social needs.

In nursing practice, esteem and self-actualization are often not the primary focus when Maslow's hierarchy is applied. Instead, attention centers on meeting the three lower-order needs: physiological, safety, and social. Nurses typically address physiological needs in their role as caregivers and sometimes also deal with safety needs — particularly those related to physical health — as well as social needs.

Conclusion: Strengths, Limitations, and Educational Implications

The simplicity of Maslow's hierarchy makes it easy to apply to a wide range of studies involving people. It was developed in psychology before rigorous scientific practice was standard in that discipline, yet it has remained influential in psychology and numerous other fields. The theory has proven surprisingly robust, but it still requires adaptation for use in nursing. As a human resources tool for nursing administrators, Maslow's hierarchy functions much as it would in any other organizational context; for nurses working directly with patients, however, specific adaptations are necessary. Many nursing theorists have made such adaptations to help practitioners better understand patient motivations. These adaptations generally focus first on immediate pain and discomfort, then on broader health concerns, and finally on social and esteem dimensions.

Some critics of the hierarchy take specific issue with its hierarchical structure, and such criticisms are embedded in a number of middle-range theories. Where the human being is understood as a holistic system, for instance, meeting social needs can produce positive change in a patient's physical condition — suggesting linkages that fall outside Maslow's framework. The application of Maslow's hierarchy in nursing theory and practice is therefore by no means universal, and it does not align well with all nursing theories.

Yet the popularity of Maslow's hierarchy persists, again because it provides a simple framework through which motivation can be understood. It has been adapted into a number of areas of nursing practice, which has helped prolong its relevance. As a future nursing educator, it is important to understand Maslow's hierarchy because of its prominence in the field. It is equally important, however, to understand its limitations and the situations in which it is unable to fully analyze a clinical scenario. It is not sufficient to teach it as established fact; it should be presented as a perspective that is common in motivational thought, but by no means universal to all humans or applicable to all nursing situations.

Calvert (1989) studied Roy's Adaptation Model and applied it to the idea that pets can help alleviate loneliness. The pets function as an environmental factor affecting adaptation, and Roy's model identifies people as interrelated systems. Meeting a social need through pet companionship can help a person feel better, which in turn may have a positive impact on physical health — a relationship that Maslow's strictly hierarchical model does not readily accommodate.

Another application of Roy's Adaptation Model concerns hearing-impaired older adults. One study applied Roy's model to the relationship between cognitive adaptation processes and self-consistency in hearing-impaired elders, finding that Roy's theoretical proposition regarding cognitive adaptation contributed significantly to the maintenance of self-consistency (Zhan, 2000). Together, these studies illustrate that Roy's model has been used to examine a variety of adaptive responses and is especially valuable for understanding how people adapt to changing health circumstances, particularly as they age.

References

Benson, S. & Dundis, S. (2003). Understanding and motivating health care employees: Integrating Maslow's hierarchy of needs, training and technology. Journal of Nursing Management, 11, 315–320.

Calvert, M. (1989). Human-pet interaction and loneliness: A test of concepts from Roy's Adaptation Model. Nursing Science Quarterly, 2(4), 194–202.

McLeod, S. (2014). Maslow's hierarchy of needs. Simply Psychology. Retrieved March 28, 2014, from http://www.simplypsychology.org/maslow.html

Villarruel, A., Bishop, T., Simpson, E., Jemmott, L., & Fawcett, J. (2001). Borrowed theories, shared theories and the advancement of nursing knowledge. Nursing Science Quarterly, 14(2), 158–163.

Zalenski, R. & Raspa, R. (2006). Maslow's hierarchy of needs: A framework for achieving human potential in hospice. Journal of Palliative Medicine, 9(5), 1120–1127.

Zhan, L. (2000). Cognitive adaptation and self-consistency in hearing-impaired older persons: Testing Roy's adaptation model. Nursing Science Quarterly, 13(2), 158–165.