Maslow’s hierarchy of needs is crucial to establishing priorities on the NCLEX-RN® exam. Maslow identifies five levels of human needs: physiological, safety or security, love and belonging, esteem, and self-actualization. Because physiological needs are necessary for survival, they have highest priority and must be met first. Physiological needs include oxygen, fluid, nutrition, temperature, elimination, shelter, rest, and sex. If you don’t have oxygen to breathe or food to eat, you really don’t care if you have stable psychosocial relationships!
Safety needs can be both physical and psychosocial. Physical safety includes decreasing what is threatening to the client. The threat may be an illness (myocardial infarction), accidents (a parent transporting a newborn in a car without using a car seat), or environmental threats (the client with COPD who insists on walking outside in 10° F temperatures).
To attain psychological safety, the client must have the knowledge and understanding about what to expect from others in his environment. For example, it is important to teach the client and his family what to expect after a CVA. It is also important that you allow a woman preparing for a mastectomy to verbalize her concerns about changes that might occur in her relationship with her partner.
To achieve love and belonging, the client needs to feel loved by family and accepted by others. When a client feels self-confident and useful, he will achieve the need of esteem as described by Maslow.
The highest level of Maslow’s hierarchy of needs is self-actualization. To achieve this level the client must experience fulfillment and recognize his or her potential. In order for self-actualization to occur, all of the lower-level needs must be met. Because of the stresses of life, lower-level needs are not always met, and many people never achieve this high level of functioning.
Use Maslow’s Needs to Establish Priorities
The first strategy to use in establishing priorities is a four-step process, beginning with Maslow’s hierarchy. To use the Maslow strategy, you must first recognize the pattern in the answer choices.
Step 1. Look at your answer choices.
If answer choices are both physical and psychosocial, it’s time to “Maslow” the answer choices.
Step 2. Eliminate all psychosocial answer choices. If an answer choice is physiological don’t eliminate it yet. Remember, Maslow states that physiological needs must be met first. While pain certainly has a physiological component, reactions to pain are considered “psychosocial” on this exam and will become a lower priority.
Step 3. Ask yourself: Does this choice make sense?
Next, consider each of the remaining answer choices. Take the time to read each choice carefully and ask yourself, “Does this answer make sense with regard to the disease or situation as described in the question?” If it makes sense as an answer choice, keep it for consideration and go on to the next choice.
Step 4. Can you apply the ABCs?
Look at the remaining answer choices. Can you apply the ABCs? The ABCs mean airway, breathing, and circulation. If there is an answer that involves maintaining a patent airway, it will be correct. If not, is there a choice that involves breathing problems? It will be correct. If not, go on with the ABCs. Is there an answer pertaining to the cardiovascular system? It will be correct. What if the ABCs don’t apply? Compare the remaining answer choices and ask yourself, “What is the highest priority?” This is your answer.
Maslow’s Hierarchy
Self-actualization
Self-esteem
Love and belonging
Safety and security
Physiological needs