Basic Needs and Comfort

Measures
Objectives
 Define basic human needs
 Define: self-actualization, self-esteem, love,
security, belonging and physiologic needs
according to Maslow’s Hierarchy of Needs
 Explain and list physiologic needs
 Define the terms associated with pain: agonist,
analgesic, biofeedback, antagonist, relaxation,
mediation, PCA, endorphins
 Understand pain measurement techniques
 Describe techniques used to relieve pain
 Evaluate effectiveness of pain control measures
Objectives
 List causes of discomfort for patients
 List nursing measures to promote comfort and
ease discomfort for patients
Human Needs
 Basic human needs: those which are common to
all people and essential for survival
 Some can be met independently; some are
dependent on relationships with others
 Food, water, shelter, warmth
 Connection, love, security, spirituality
Basic Human Needs have the following
characteristics

 The absence of a basic human needs being met

results in illness.
 The presence of basic human needs being met
help prevent illness or signals health.
 Meeting basic human needs restores health.
 It is preferred over other satisfactions when
unmet
 One feels something missing when needs are
unmet.
 One feels satisfaction when needs are met.
Basic Human Needs
 Level 1: Physiologic - oxygen, water, food,
temperature, elimination, sexuality, physical
activity and rest
Most basic needs and have the highest priority
Usually can be met through self-care, but many
people who are ill require assistance
 Level 2: Safety and security - safe
environment, protection from violence, safe
emotional environment
 Level 3: Love and belonging needs -
understanding and acceptance of others;
belonging to a community
Basic Human Needs
 Level 4: Self-Esteem needs - need to feel pride
and a sense of accomplishment, respect,
appreciation
Can be affected by body image, role changes
 Level 5: Self-Actualization needs - need to
reach one’s own full potential
Maslow
 Professor of psychology at Brandeis University
who founded humanistic psychology
 Created the Theory of Basic Human Needs
 Useful for understanding the relationships of
basic human needs and for establishing priorities
of care
 Theory of Basic Human Needs is a foundation for
nursing care and interventions
Abraham Maslow (1908 - 1970)
Maslow’s Hierarchy of Needs
 Certain needs are more basic than others
 All people have the same needs all of the time,
people generally strive to meet certain of their
needs before attending to others
 Level 1: Physiologic needs
 Level 2: Safety and security needs
 Level 3: Love and belonging needs
 Level 4: Self-esteem needs
 Level 5: Self-actualization needs
Level 1: Physiologic Needs
 A need which must be met at least minimally to
maintain life; the most basic in the hierarchy and
therefore with the highest priority
 Most healthy children and adults can meet these
needs through self-care
 Very young, old, disabled and ill people requires
assistance in meeting them
 The lack of any of the following cause discomfort
 Oxygen: respiratory diseases, cardiac disease
 Water: dehydration, hypovolemia,
 Food: starvation, NPO
 Warmth
Level 2: Safety and security
needs
 Involves both physical and emotional components
 Physical security:
1. Using hand hygiene and sterile techniques to
prevent infection
2. Using electrical equipment properly
3. Administering medications knowledgeably
4. Using skill when moving and ambulating
patients
5. Assessing patients for potential risks, such as
falling, bleeding, infection
Level 2: Safety and security
needs
 Emotional safety and security: being free from
fear, anxiety and apprehension
 Patients entering health care system face fear of
the unknown, their prognosis, unfamiliar
surroundings, unfamiliar personnel
 All patients have anxiety
 Comfort measures: explain procedures, friendly,
unhurried approach, continuity of caregivers,
relationship building.
Level 3: Love and Belonging Needs
 All humans have this need
 Called a higher-level need
 Includes understanding, acceptance and a feeling
of belonging to families, peers, friends,
community
 Nursing interventions to help meet this need:
 Including family and friends in the care of the
patient
 Establishing a nurse-patient relationship based
on mutual understanding and trust (by
demonstrating caring, encouraging
communication and respecting privacy)
Self esteem
 Self-esteem is your overall opinion of yourself —
how you feel about your abilities and limitations.
When you have healthy self-esteem, you feel
good about yourself and see yourself as
deserving the respect of others. When you have
low self-esteem, you put little value on your
opinions and ideas. You might constantly worry
that you aren't good enough.
Level 4: Self-Esteem Needs
 Need for the person to feel good about him or her
self, pride and a sense of accomplishment
 Factors which impact self-esteem: role changes,
body-image changes as a result of illness,
surgery
 Nursing interventions: respecting patients values
and beliefs, encouraging patients to meet
attainable goals
Self Actualization
 It refers to the desire for self-fulfillment, namely, to
the tendency for him to become actualized in
what he is potentially. This tendency might be
phrased as the desire to become more and more
what one is, to become everything that one is
capable of becoming."
 While the theory is generally portrayed as a fairly
rigid hierarchy, Maslow noted that the order in
which these needs are fulfilled does not always
follow this standard progression. For example, he
notes that for some individuals, the need for self-
esteem is more important than the need for love.
For others, the need for creative fulfillment may
supersede even the most basic needs.
Self-Actualization
Characterized by:
1. acceptance of self and others as they are
2. focus of interest on problems outside oneself
3. ability to be objective
4. feelings of happiness and affection for others
5. Respect for all people
6. Ability to discriminate between good and evil
7. Creativity in solving problems and pursuing
interests
Level 5: Self-Actualization
Needs
 The need for individuals to reach their full
potential through development of their unique
capabilities
 In general, the lower level needs must be met
before this need can be satisfied.
Nursing Process
Assessment

Evaluation Diagnosis

Intervention Planning
Nursing Process
 Assessment: gathering information, data
 Diagnosis: Name the problem
 Planning: State an achievable goal
 Interventions: Actions that work toward the stated
goal
 Evaluation: Did the plan/interventions meet the
stated goal
Nursing Interventions to Meet Patient
Needs
 Physiologic needs usually take priority
 Basic human needs are interrelated
 Examples:
 ER patient with an MI:
 Level 1 needs?
 Level 2 needs?
 Level 3,4,and 5 needs?
 Post-surgical patient in pain
 Pt. NPO for surgery
 Question
A nurse who focuses attention on the strengths
and abilities of his patients rather than their
problems is helping them to achieve which of
Maslow’s basic human needs?
A. Self-actualization
B. Self-esteem
C. Love and belonging
D. Safety and security
E. Physiologic
 Answer
Answer: A. Self-actualization
Rationale:
To meet patient self-actualization needs, nurses provide a sense of
direction and hope and maximize patient potential.
Self-esteem needs are met by respecting patient values and beliefs and
setting attainable goals for them.
Love and belonging needs are met by including family and friends and
establishing caring relationships with patients.
Safety and security needs are met by encouraging spiritual practices
and independent decision making.
Physiologic needs are needs that must be met to maintain life.
Comfort and Discomfort
 Physiologic Discomfort can come from:
 Pain
 Nausea and Vomiting
 Shortness of breath
 Hunger
 Thirst
 Inactivity
 Constipation
Comfort Measures - Pain
 Subjective data are information from the client's
point of view (“symptoms”), including feelings,
perceptions, and concerns obtained through
interviews. Objective data are observable and
measurable data (“signs”) obtained through
observation, physical examination, and laboratory
and diagnostic testing.
Pain
 Def: an unpleasant, subjective sensory and
emotional experience associated with actual or
potential tissue damage or described in terms of
such damage
 It is a red flag indicating that something is wrong:
“Protective in nature”
 Such an indicator of health that it is called the “5th
Vital Sign”
Pain
 American Bar Association: Pain relief is a legal
right

 Therefore: Nurses are legally and ethically

responsible for managing pain and suffering

 McCaffrey: “Pain is whatever the experiencing

person says it is, existing whenever he says it is.”
Common Responses to Pain

 Physiologic: increased BP, RR and pulse; pupil

dilation, muscle tension, pallor; increased
adrenalin, increased blood sugar
 Behavioral: moving away from painful stimuli,
crying, moaning, restlessness
 Affective: withdrawal, stoicism, anxiety,
depression, fear, anger, anorexia, fatigue,
hopelessness, powerlessness
Categories of Pain
 Duration
 Location or source
 Mode of transmission
 Etiology
Pain: Duration
 Acute pain: rapid in onset, varies in intensity from
mild to severe; warning signal that something
is wrong (cut finger, sore throat, headache)

Chronic pain: may be limited, intermittent or

persistent, but lasts belong the normal healing
period. Can be periods of remission or
exacerbation. (cancer pain, back pain). Interferes
with normal functioning
Pain: Location or Source
 Cutaneous Pain (superficial) usually involves the
skin of subcutaneous tissue: paper cut
 Somatic Pain originates in tendons, ligaments,
bones, blood vessels and nerves: sprains,
broken bones
 Visceral pain is poorly localized and originates in
body organs in the thorax, cranium, and
abdomen: stomach pain
 Question
A patient who has bone cancer is most likely
experiencing which of the following types of pain?
A. Cutaneous
B. Somatic
C. Visceral
D. Referred
 Answer
Answer: B. Somatic
Rationale:
Deep somatic pain is diffuse or scattered and
originates in tendons, ligaments, bones, blood
vessels, and nerves.
Cutaneous pain usually involves the skin or
subcutaneous tissue.
Visceral pain is poorly localized and originates in
body organs.
Referred pain is pain that originates in one part of
the body and is perceived in an area distant to
that part.
Origin of Pain
 Physical—cause of pain can be identified
 Psychogenic—cause of pain cannot be identified
 Referred—pain is perceived in an area distant
from its point of origin
Pain: Mode of transmission
 Referred Pain: pain which is perceived in an area
of the body distant from its point of origin
 Heart Attack or Myocardial Infarction: pain is felt
in shoulder, jaw, or arms
Referred Pain
Pain: Etiology
 Neuropathic pain: pain resulting from an injury of
or abnormal functioning of peripheral or central
nervous system (fibromyalgia, peripheral
neuropathy)
 Intractable: pain that is very resistant to
treatment
 Phantom Pain: pain in an amputated limb
Peripheral Neuropathy
Terms to know
 Agonist: a drug that binds with a receptor to
produce a therapeutic response
 Analgesic: drug that relieves pain
 Antagonist: a drug that binds to a receptor to
prevent the action of an agonist
 Placebo: “an inactive substance that gives
satisfaction to the person using it”
 Nociceptors: Peripheral nerve fibers that transmit
pain
The Pain Process
 Transduction—activation of pain receptors
 Transmission—conduction along pathways (A-
delta and C-delta fibers)
 Perception of pain—awareness of the
characteristics of pain
 Modulation—inhibition or modification of pain
Pain Process: Transduction,
Transmission, Perception, Modulation
Stimulator of Nociceptors or
Pain Receptors
 Bradykinin: powerful vasodilator, trigger release
of histamine (redness, swelling, inflammation)
 Prostaglandins: hormone-like substances that
send additional pain stimuli to the CNS
 Substance P: sensitized receptors on nerves to
feel pain

 These are Neurotransmitters: substances that

excite or inhibit target nerve cells
Pain Reception
Pain Receptor Stimulators
 Mechanical - friction
 Thermal - heat or cold
 Chemical - acid
 Electrical- static electricity
Perception of Pain
 Pain threshold: lowest intensity of a stimulus that
is recognized as pain
 Adaptation: “getting used to the stimulus”
 Modulation of pain: sensation of pain is modified
or lessened by naturally produced chemical
substances
 Neuromodulators
 Endorphins, dynorphins, enkephalins
Gate Control
Theory of Pain
 States that certain small nerve fibers conduct
pain impulses toward the brain
 Certain large nerve fibers appear to block pain
impulses toward the brain
 A “gating mechanism” occurs when too much
information is sent to the brain and the pain signal
is interrupted
 The brain can influence its own gating
mechanism through past experiences and
learned behaviors
Gate Control Theory
Factors Affecting Pain Experience
 Culture
 Ethnic variables
 Family, gender, and age variables
 Religious beliefs
 Environment and support people
 Anxiety and other stressors
 Past pain experience
General Assessments of Pain
 Patient’s verbalization and description of pain
 Duration of pain
 Location of pain
 Quantity and intensity of pain
 Quality of pain
 Chronology of pain
Pain Scale
Symptom Analysis
 P, Q, R, S, T
 P = Place: where is the pain (or other symptom)?
 Q= Quality: what does it feel like?
 R = Radiation: does it go anywhere else?
 S = Severity:how bad is it? Rate it on a 1-10 scale
 T = Time: how long have you had this?
Nursing Interventions for Pain
 Establishing trusting nurse–patient relationship
 Manipulating factors affecting pain experience
 Reviewing additional pain control measures
 Initiating nonpharmacologic and pharmacologic
pain relief measures
 Considering ethical and legal responsibility to
relieve pain
 Teaching patient about pain
Establishing a Relationship
Manipulating Factors Affecting
Pain
1. Remove or alter the cause of pain: change
body positions, empty distended bladder, loosen
tight bindings
2. Alter factors affecting pain tolerance: promote
rest, sleep; encourage use of pain medication
3. Initiate non-pharmacologic relief measures:
distraction, humor, music, imagery, relaxation
techniques, cutaneous stimulation (TENS unit),
hypnosis, biofeedback, therapeutic touch
Transcutaneous electrical nerve
stimulation (TENS unit)
Pharmacologic Pain Relief Measures
Selecting analgesics
 Pharmacological – Analgesics
1. Non-opiods – act on peripheral nerve ending at
the injury site (Tylenol, NSAIDS)
2. Opiods – Act on the CNS (Morphine, Codeine,
Demerol; also synthetic opiods like Dilaudid)
3. Adjuvants/Co-analgesics – Used in combination
with opiods (benzodiazapines: Valium, Ativian)
Selecting analgesics - WHO
Ladder
Additional Methods for
Administering Analgesics
 Patient-controlled analgesia
 Epidural analgesia
 Local anesthesia
PCA pump: Patient Controlled
Analgesia
PCA: Patient Controlled
Analgesia
Placement of an Epidural Catheter
Scheduling Analgesic Doses
 Preventive approach to pain management is
crucial
 Nurses should be able to anticipate procedures
and activities which will cause pain and pre-
medicate the patient
 Pain should be controlled “ATC” or around the
clock with long-acting medications and/or prn with
“break-through” medications
 When pain is out of control, larger doses are
required
Comfort and Discomfort
 List some attributes that you might associate with
discomfort
 Examples: pain, nausea, fear, hunger, thirst,
dark, worry
 List some other examples
Comfort and Discomfort
 List some attributes associated with comfort:
 Examples:
 Warmth, softness, rest, quiet, coolness,
cleanliness, space, safety
 Name some more that you associate with comfort
Comfort Measures
 Provide quiet, clean, uncluttered environment
 Provide warmth or coolness as indicated
 Provide personal hygiene: keep patient clean and
dry, linen changes, oral care
 Provide activity as indicated: TV, radio, reading
material
 Explain all procedures, tests, hospital routines
 Facilitate family visits and support
 Check with patient at regular intervals about his
comfort/discomfort
 Keep call light within reach and encourage patient to
call you if needed
Focus on the Patient