Lesson 1 Patient Relations

1.1 Basic Human Needs and Principles of Health

Health is one of our most precious possessions. The preservation of health is met through the satisfaction of our basic human needs. Understanding the basic needs of people, therefore, is essential for the practical nurse in planning for and meeting the needs of the patient.

PRINCIPLES OF HEALTH

a. Definition of Health.

(1) An individual's concept of health is a very personal thing. 0ne person may consider himself to be healthy whenever he is not physically ill, while another may consider himself to be healthy only when he is emotionally and physically "at his best." A person's notion of health is influenced by a number of different factors or experiences, such as family background, self-concept, religion, past experiences, and socioeconomic status. It is important that you, as a practical nurse, keep this in mind when dealing with your patient's, as well as your own, feelings and interactions.
(2) For purposes of this course, we will define health as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.

b. Total Health. Although the absence of disease and illness is, by anyone's definition, essential to good health, it is, by no means, the only factor. Total health includes all of the following aspects as well:

(1) Social health. A sense of responsibility for the health and welfare of others.
(2) Mental health. A mind that grows, reasons, and adjusts to life situations.
(3) Emotional health. Feelings and actions that bring one satisfaction.
(4) Spiritual health. Inner peace and security in one's spiritual faith.

THE HEALTH-ILLNESS CONTINUUM

a. An individual's state of health is one of continual change. He moves back and forth from health to illness and back to health again. His condition is rarely constant. He may wake up feeling great, develop a headache mid-morning, and feel fine again by noon. The health-illness continuum (see figure 1-1) illustrates this process of change, in which the individual experiences various states of health and illness (ranging from extremely good health to death) that fluctuate throughout his life.

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Figure 1-1. The health-illness continuum.

b. As we previously stated, health, just as life itself, is a process of continual change. And we must continually adapt to these changes in our lives in order to maintain good health and well-being. It is our adaptation or response to that change, rather than the change itself, that affects our health. For example, two students just found out about a big test tomorrow, for which they are completely unprepared. One student responds to this stressful situation (stressor) by going home, getting his books out, and starting to study. The other student breaks out into a sweat, and spends most of the evening fretting over this outrage and imagining what will happen to him if he doesn't pass the test. No doubt, this student is doing more damage to his health than is his friend. And, considering the time and energy he is expending on worrying (and not studying), he may experience even more stress when they receive their grades!

c. Adaptation and effective functioning, even in the presence of chronic disease, can be considered a state of wellness. A person may be in perfect physical condition, but feel too tired and "blue" to go to work, while his co-worker, a diabetic, is at work, functioning fully and accomplishing his job. Which of these two people is at a higher level on the health-illness continuum?

NOTE:

Death occurs when adaptation fails completely, and there is irreversible damage to the body.

 ADAPTING TO CHANGE

The individual's state of health is determined by the ability to adapt to changes in the following dimensions:

a. Developmental--changes in a person's behavior and ability, which are associated with increasing age.
b. Psychosocial--the development of the personality, social attitudes, and skills.
c. Cultural--changes in or development of beliefs and values held by the individual's family or culture.
d. Physiological--changes in body function.

 POSITIVE HEALTH HABITS

Regardless of one's definition of health, the individual who practices the following positive health habits on a regular basis is certainly at an advantage.

a. A balanced diet with adequate caloric intake.
b. Efficient elimination.
c. Regular exercise.
d. Adequate sleep, rest periods, and relaxation periods.
e. Regular medical checkups.
f. Regular dental checkups.
g. Maintenance of good posture.
h. Good grooming habits.

CATEGORIES OF BASIC HUMAN NEEDS

a. Physical Needs. These are closely related to body functions and are sometimes referred to as primary or physiological drives. Physical needs include:

(1) Food.
(2) Water.
(3) Oxygen.
(4) Elimination.
(5) Clothing and shelter for body warmth and protection.
(6) Activity, or sensory and motor stimulation, including sex, physical exercise, and rest.

b. Emotional Needs. Emotional needs are closely interwoven with physical needs and are met in interaction with significant others. They include:

(1) Love, including approval and esteem.
(2) Importance, including recognition and respect.
NOTE: This applies to the patient's perception of the nurse's feelings toward him. For example, if your patient feels that you do not approve of or respect him, he may become very demanding, or he may withdraw and not cooperate with your efforts to make him healthy again.
(3) Adequacy, including self-sufficiency and the need to be needed and wanted.
(4) Productivity, including work and creative pursuits.

c. Social Needs. Social needs grow out of the culture and society of which one is a member. They include:

(1) Identification or belonging.
(2) Education or learning.
(3) Recreation or play.
(4) Religion or worship.
NOTE: Remember that all human behavior is aimed toward the satisfaction of basic human needs.

MASLOW'S HIERARCHY OF NEEDS

Psychologist Abraham Maslow defined basic human needs as a hierarchy, a progression from simple physical needs to more complex emotional needs (see figure 1-2).

a. Types of Needs.
(1) Physiological--food, shelter, water, sleep, oxygen.
(2) Safety--security, stability, order, physical safety.
(3) Love and belonging--affection, identification, companionship.
(4) Esteem and recognition--self-esteem, self-respect, prestige, success, esteem of others.
(5) Self-actualization--self-fulfillment, achieving one's own capabilities.
(6) Aesthetic--beauty, harmony, spiritual.

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Figure 1-2. Maslow's hierarchy of needs.

b. Relationship Between Levels of Needs.

(1) According to Maslow, the basic physiological needs related to survival (food, water, etc.) must be met first of all.
(2) These basic physiological needs have a greater priority over those higher on the pyramid. They must be met before the person can move on to higher level needs. In other words, a person who is starving will not be concentrating on building his self-esteem. A patient in severe pain will not be concerned with improving his interpersonal relationships.
(3) Generally speaking, each lower level must be achieved before the next higher level(s) can be focused upon.

c. Relationship Between Levels of Needs.

(1) According to Maslow, the basic physiological needs related to survival (food, water, and so forth.) must be met first of all.
(2) These basic physiological needs have a greater priority over those higher on the pyramid. They must be met before the person can move on to higher level needs. In other words, a person who is starving will not be concentrating on building his self-esteem. A patient in severe pain will not be concerned with improving his interpersonal relationships.
3) Generally speaking, each lower level must be achieved before the next higher level(s) can be focused upon.

COMPARISON OF BASIC HUMAN NEEDS AND MASLOW'S HIERARCHY OF NEEDS

The categories of Maslow's hierarchy are closely related to the basic human needs discussed in paragraph 1-6. Table 1-1 contains a comparison.

Maslow's Hierarchy of Needs

Basic Human Needs

Physiological:
Food, shelter, water, sleep, oxygen

Safety:
Security, stability, order, physical safety

Physical Needs:
Food, water, oxygen, elimination, clothing and shelter for body, warmth and protection, activity, or sensory and motor stimulation, including sex, physical exercise, and rest
Love and Belonging:
Affection, identification, companionship

Esteem and Recognition:
Self-esteem, self-respect, prestige, success, esteem of others

Emotional Needs:
Love, including approval and esteem, importance, including recognition and respect, adequacy, including self-sufficiency and the need to be needed and wanted, productivity, including work an creative pursuits
Self-actualization:
Self-fulfillment, achieving one's capabilities

Aesthetic:
Beauty, harmony, spiritual

Social Needs:
Identification or belonging, education or learning, religion or spiritual, recreation or play

Table 1-1. Comparison of basic human needs and Maslow's hierarchy of needs.

a. Physical needs are roughly equivalent to Maslow's physiological and safety needs.
b. Emotional needs are roughly equivalent to Maslow's love and belonging and esteem and recognition needs.
c. Social needs are roughly equivalent to Maslow's self-actualization and aesthetic needs.

CLOSING NOTE

Remember that human needs are not constant; they are fluid and changing with first one, then another, taking priority. What may start as a basic need for food can take on social and personal significance. Your care plan as well as your patience are aimed toward the satisfaction of the patient's needs. He has common needs because he is a person; he has individual needs because he is unique; he has special needs because he is sick. The Practical Nurse supplies the help that is required to meet the patient's needs during the stressful periods of hospitalization and recuperation.