WWMD?

Maslow Hierarchy of Needs

Inevitably, when studying for any psychiatric nursing exam (psych nursing class in school, the NCLEX, ANCC’s PMHN Exam or its Nurse Practitioner licensure exam,) you’re going to come across references to Abraham Maslow’s Hierarchy of Needs. And I’ll bet at some point in your studies you’ve had a moment where you’ve asked yourself, “Why is this guy’s work so darn important?”

I used to approach Maslow’s work as one of those concepts I’d just need to memorize in order to pass whatever exam I was facing. I honestly never considered his concepts very helpful in my every day practice.

Turns out, I couldn’t have been more wrong. Of all the theorists, Maslow’s concepts are actually the most helpful in understanding our patients and their behaviors…and is certainly the most important in preparing for the PMH exam.

Remember, Maslow built his Hierarchy of Needs pyramid with most fundamental human needs (required to continue to live) at the base and spiritual awakening and transcendence at the very top. His concept was that you couldn’t really skip any of these building blocks–each one had to be in place and satisfactorily met before the next set of needs could be addressed.

If you think about it, that makes perfect sense. Ever try to have a serious conversation with someone when your blood sugar was tanking? What about paying attention to a lecture when your bladder was so full you thought it might burst? Physical needs and feeling safe are going to override everything less important.

Let me give you a real life example that happened a couple of weeks ago. A PMH nurse was struggling to get through the initial assessment of a patient we were admitting into the hospital. The patient “wasn’t cooperating,” according to the nurse. When I went over to offer support and assistance, I quickly discovered that the patient was homeless and, even more importantly, hungry. In her psychiatrically impaired state, she was loudly accusing the nurse of not caring about her (which by the way is code for “I don’t trust you”) and was refusing to answer a lot of the nurse’s questions. Why? Because the nurse was “refusing” to give the patient any food until the patient was fully admitted.

If we look at this through Maslow’s lens, everything becomes clear: the patient’s most primary need–food–was not being met, and until that need was met, she couldn’t even think about doing anything more complex. The nurse’s stance on this was, I’m afraid of giving her anything until I’ve ensured that the food I give her will be safe for her. So it was kind of a stalemate. Kind of.

Actually, all it took to break the stalemate was to ask the patient if she had diabetes or any allergies. Once the patient said no to both, I asked the patient if some juice and a granola bar would be an acceptable snack, just until we could get her onto the unit when she could have a real meal. Instantly, her demeanor changed, she enthusiastically agreed, and the admission was completed without further incident while I went to the kitchen to fetch the snack.

With the ANCC PMHN exam, there will be several questions asking you to prioritize tasks. Using Maslow’s concepts, you can look at the options they give you and think to yourself, “What is the patient’s most important need right now?” In the question given, is there anything that threatens the patient’s physical well being, such as a significantly abnormal lab value or vital sign? Are the patient’s airway, breathing, and cardiac systems are all functioning normally? These will be the most important things to address first, If there’s no threat to the patient’s well being, move to the next level–is there a threat to the patient’s safety? Is the patient suicidal? Is the patient being subjected to domestic violence? These must be addressed before we start doing something further down on the importance scale like, for instance, patient education.

So whether it’s real life patient care or an exam question testing your ability to triage patient care, just stop and ask yourself: What Would Maslow Do?