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Journal ofAdvanced Nursing,1986,11,643-649

The Human Needs Model of Nursing

Jean Minshull SRN SCM RCNT DN(Lon) DANS(Man) RNT Senior Tutor, Curriculum
Development, Kathryn Ross SRN OND SCM RCNT RNT Nurse Tutor, Curriculum Development
and Janet Turner SRN SCM RCNT DN(Lon) DANS(Man) RNT MSc(Man) Joint Appointee,
South Munchester School of Nursing, Munchester

Accepted for publication I4 January 1986

MINSHULL J., ROSS K. & TURNER J. (1986) Journal ofAdvancedNursing 11,643-649


The Human Needs Model of Nursing
Nurses in the United Kingdom spend much time attempting to fit British nursing practice into
the theoretical framework of American nursing models. This is often a manipulative process in
that it seeks to establish positive links with a care delivery system totally unlike our own. In the
present paper the authors detail the process of establishing a new nursing model which
integrates nursing curricula, education and practice to meet the needs of patients, staff and
students within their own health district. An over-emphasis on lower levels of human need is
common within nursing practice, which, although often blamed upon lack of human and
financial resources, is also due to practitioners misconceptions. The latter are invariably the
result of a lack of an adequate or overt, practice orientated, conceptual framework. The
Human Needs Model of Nursing adapts Maslows concept of human needs to create such a
conceptual framework for practice. It places equal emphasis on those patient problems which
arise as the result of unmet needs at higher levels as well as those at lower levels, thereby
acknowledging the holistic and dynamic nature of man.

NURSING MODELS nurse and thus a rejection of a medical model


approach to both nursing practice and nurse
Like most relatively new concepts, nursing education. Nursing models are therefore begin-
models are viewed with suspicion and scepticism ning to be utilized in the development of nursing
by the majority of nurses. The nursing process curricula but are not always being translated
initially suffered the same fate, being viewed as into practice. A commitment (by the South
implicit criticism of British methods of nursing Manchester School of Nursing within our own
care delivery. The nursing profession may soon health district) to avoid this lack of professional
be in the position where practitioners directly congruence in the process of translating curricu-
involved in care delivery reject nursing models as lum theory into the reality of nursing practice led
purely academic attempts at defining nursing us to clearly determine the first two essential
reality. This would mean losing valuable tools steps in the re-writing of the registered general
which, when used effectively, provide nurses nurse curriculum. These were seen as:
with a realistic framework for their care delivery.
Over the past few years there has been an 1 that a district philosophy of nursing be
increasing awareness of the unique role of the determined; and
2 that nursing model(s) should be selected
Correspondence: J. Minshull, South Manchester School of
Nursing, Mauldeth House, Mauldeth Road West, Manchester upon which the curriculum could be based, in
M212RL. agreement with Newman & Young (1972)

643
644 J . Minshull et a1

who state that the nursing model selected by 6 Description of the basic components
the school provides the conceptual basis. included in the model.
needed unity, co-ordination and integration 7 Relationships of basic concepts of the
for curriculum development. person, environment, health and nursing.

In relation to establishing the philosophy, 14 A nursing model which met all the stated
structured group discussions took place within criteria was not found. This was especially so in
the district to involve a one in ten representative relation to the stated requirement to place equal
sample of nursing staff (including both trained emphasis on all aspects of human need. Some
staff and students) in determining a statement of commonly used models tend to concentrate on
beliefs and values about nursing and related the physical aspects of patient care, e.g.
issues. In total 320 staff participated in this pro- Henderson (1966) directs 57% of the com-
cess and the result was the formulation of the ponents of basic nursing care towards physical
South Manchester Philosophy of Nursing aspects, whilst Roper et al. (1980) devote 58% of
(South Manchester School of Nursing 1983). nursing activities to these aspects. In view of this
The authors then participated with other edu- lack of major emphasis on other than physical
cational staff within the school of nursing in the aspects of nursing care the authors decided to
process of nursing model selection. The authors create a new model of nursing which fulfilled the
believe that for nursing models to be effective in stated criteria, and which could be utilized both
influencing the quality of patient care delivery as a basis for curriculum development and also
they must be selected according to specifically for translation into nursing practice. The Human
stated criteria. The authors identified the Needs Model of Nursing was the result of this
following five criteria. process.

The philosophy of nursing of the district


should be reflected in the chosen model.
It should adequately meet the patient needs THE INDIVIDUAL
\cithin the district. (These specific needs
encompass such things as the socioeconomic In defining the person within this model, the
status of the geographical catchment area, philosophy of nursing of the health district was
the speed ofpatient turnover and the stage of utilized; this is based upon individual needs and
professional awareness of the caregivers.) upon a humanistic approach to both nursing
i t should be readily understood by all levels and nurse education. A framework was then
ofnursing staff. sought within which human needs could readily
It should be translatable into nursing be described. Having completed the literature
practice. search the authors accepted Maslows (1954)
Equal emphasis should be given to all aspects theory of human needs as a means of describ-
of human needs. ing man and adapted this as an integral part of
this model. In 1954 Maslow put forward a moti-
Having established these criteria the authors vational theory in relation to a hierarchy of
undertook a literature search for an appropriate human needs which defined five levels of need,
nursing model. Throughout the search the i.e. physical, safety and security, love and
following framework for analysing nursing belongingness (within this model the terms love
models was utilized (Fitzpatrick & Whall 1983). and belongingness are replaced by the word
affiliation), dignity and self-esteem, and self-
1 Definition of the person, nursing. health. actualization. He proposed that the individual
environment. would only be motivated to meet higher needs
2 Description of nursing activity. once the lower needs within the hierarchy were
3 Understanding of the person. met. This premise that one need level must be
4 Understanding of health. met before other levels become important is
5 Inter-relationships among concepts of the rejected within this model. (In the second
person, environment, health and nursing. edition of his work, Maslow (1971) himself
The Human Needs Model of Nursing 645

FIGURE 1 The Human Needs Model of Nursing

acknowledged that the hierarchy of human psychological, spiritual and social needs. He is
needs was less clearly able to be defined than he viewed as unique, of intrinsic value, and the
had previously thought.) An essential element centre of his own reality (Rogers 1980). The
of the Human Needs Model of Nursing is that it authors have accepted five categories of human
places equal emphasis upon each level of human need which have been adapted from Maslows
need. Further, the hierarchy is important in the (1954) original work. Each of the categories
assessment of the individual in that physical defined within the model is not intended to be
needs in the patient which are unmet may be life definitive but rather a descriptive example.
threatening, as may unmet needs in the category Unmet needs in the individual can lead to prob-
of safety and security. lems, and these problems are viewed as either
There have been criticisms of the use of patient problems, because the individual is
Maslows ideas in nursing models (Webb 1984) aware of the unmet need, or nursing problems
but this is largely due to either attempts by nurses because the individual is unaware of the unmet
to apply Maslows motivational theory directly need.
to nursing care, or to its over-simplification by
authors such as Roper et al. (1983). Other criti-
cisms are related to the utilization of psychologi-
cal theories in the creation of nursing models, Category 1: physical needs
but as McGlynn (1983) points out to construct
models of nursing which are acceptable, This is the first category of human need and
theories must be generated or borrowed from consists of those things which the individual
life sciences appropriate to the needs of patient requires to maintain physiological homeostasis,
and nursing care. e.g. nutrition, elimination, heat and cold,
An important factor which also influenced the mobility, sleep and rest, light and darkness,
authors in the decision to utilize an adaption of quietness and noise, hygiene, oxygen and car-
Maslows theory, was the experience of one of the bon dioxide, sensory stimulation. Unmet needs
authors in applying this concept to direct indi- in this category result in patient problems which
vidualized patient care within the clinical area could become immediately life threatening if
where it proved extremely valuable (Minshull ignored, e.g. airway obstruction, as well as such
1978). things as hunger, dehydration, constipation,
The individual within this model is viewed etc. Sensory needs are also included in this cate-
holistically, having interdependent physical, gory which, although not vital to physiological
646 J . Minshull et al.

homeostasis, cannot be ignored if the individual status, fame and glory, dominance, recognition.
is to be viewed holistically. attention, importance, dignity, or appreciation.

Another important aspect of this category is the


Category 2: safety and security need for privacy and an involvement in
decision-making processes about oneself o r
Included in this category of need are those things meaningful others. Unmet needs in this cate-
which create a safe, orderly, predictable, lawful gory lead to feelings of inadequacy, worth-
and organized life. Examples of means of par- lessness, dependence, loss of motivation and
tially fulfilling these needs are such things as degradation.
routine, rhythm and familiar and stable sur-
roundings, whereas needs for financial and social
stability are met by being able to work and thus Category 5 self-actualization
feel a contributing member of society. The need
to be free from fear is vital to psychological This category of human need is viewed as the
security and unmet needs in this category can individual reaching their full potential. Maslow
lead to problems of anxiety. disorientation and (1 971) defined self-actualization as experienc-
abnormal behaviour. ing fully, visibly, selflessly, with full concen-
tration and total absorption. However, as
Maslow himself pointed out, it is likely that
Category 3: affiliation needs only a small proportion of individuals enter this
dimension for any substantial amount of time,
This category includes the more intangible and that even these may only experience this
needs; namely the concern with the establish- state transiently. It is accepted within the model
ment and maintenance of positive affectionate that although the nurse cannot directly meet
relationships with other persons and with the needs in this category that where all other cate-
desire to be liked and respected (Atkinson et al. gories of human need are met the individual
1954). Hence the need for meaningful others - can be left free to explore the self-actualizing
for family, friends, children. colleagues, pets, dimensions of his illnessilife.
group and societal membership and, in par-
ticular, the need to have contact and to give
and receive love. Unmet needs in this category THE LIFE CONTINUUM
result in loneliness, rejection, friendlessness,
rootlessness and alienation. For the purpose of this model, life is conceptual-
ized as a continuum ranging from maximal
wellness, which equates with independence, to
Category 4: dignity and self-esteem maximal illness which equates with dependence.
This continuum can be seen to be both quanti-
These needs are related to independence and tative in relation to the nurses perspective and
individual achievement, as Maslow (1971) qualitative in relation to the patient; in that the
states. nurse will be involved in quantifying that which
the patient expresses or manifests (in terms of
All people in our society (with a few pathological clinical features, etc.) whereas the patient will
exceptions) have a need or desire for a stable, firmly describe the situation or illness from a subjec-
based. usually high evaluation of themselves. for self- tive viewpoint. That is not to say that either per-
respect or self-esteem. and for the esteem of others.
spective is exclusive but rather to demonstrate
These needs may therefore be classified in two sub-
sidiar! sets. These are first, the desire for strength, for
an awareness of the possible tangential views of
achievement, for adequacy. for mastery and compe- the patient situation. The individual is conceptu-
tence. for confidence in the face of the world and for ally represented along this continuum within
independence and freedom. Second, we have what the framework of a triangle. O n the wellness
we may call the desire for reputation or prestige side of the continuum the triangle is upright,
(defining it as a respect or esteem from other people), representing the individual in a relatively stable
The Human Needs Model of Nursing 641

state. On the illness side of the continuum the only support the individual if she has ascer-
triangle is inverted and thus is unstable, requir- tained the meaning of the situation and experi-
ing the support of the nurse in the appropriate ences for that individual. It is remembered that
category in order to become relatively stable. an unmet need becomes a problem, one which
Within this model the authors accept Kasle & may not be perceived by the individual; perhaps
Cobbs (1966) definitions of wellness and illness, due to a lack of specialist knowledge, the very
which are: wellness -when the individual per- nature of the illness, or because the individual is
ceives himself or herself to be healthy for the so ill that he is unaware of many needs at differ-
purpose of maintaining health and preventing ing levels. The unique function of the nurse is to
illness; illness -an activity undertaken by a identify individual problems related to human
person who believes himself or herself to be ill needs in order to plan and deliver nursing care
for the purpose of diagnosing a condition and which will provide support in those categories
discovering a cure. of need where the patient is unable to remain
The individual (represented by the stable or independent. The accuracy of the assessments
unstable triangle) can conceptually be placed made and the effectiveness of the care subse-
anywhere along the continuum depending upon quently planned must be evaluated.
their health status. It is also postulated by the
authors that even within wellness individuals can
The nurses role in wellness
become relatively dependent on nursing support
whilst remaining well, e.g. a blind diabetic The support provided by a nurse when a person
person in the community requiring direct support is in a state of wellness may be viewed as being
from the nurse. Whilst on the illness side of the predominantly indirect in nature, that is in the
continuum, an individual may remain indepen- promotion of health and the prevention of ill-
dent whilst also being removed from a state of ness. These considerations underpin the first
wellness, e.g. the individual being admitted for two competenciesrequired of a registered general
planned surgery who can be seen to be ill but nurse (United Kingdom Central Council 1983),
independent. namely to:

1 advise on the promotion of health and the


THE NURSE prevention of illness; and
2 recognize situations that may be detrimental
Clark (1982) makes the critical point that most to the health and well being of the individual.
nursing models assume a sick patient whereas
many nurses nurse individuals who are well. This is not to suggest that these are not essential
Thus, to develop a model which is considered components of all nursing situations, rather
capable of application to various situations that here there is emphasis placed on the indi-
where student nurses learn to integrate theory vidual who is able, predominantly, to meet his
and practice and develop an understanding of needs unaided. Thus the nurse aims to support
the nurses role, emphasis on that role in both the person in maintaining a state of health and
health and illness is paramount. The nurses wellness. Actions may be seen as ranging from
role within this model is viewed as a supportive the provision of information to enable indi-
one; support being provided either directly or viduals to make informed decisions (including
indirectly in enabling or helping the individual support during and after the decision-making
to meet their needs to achieve maximal well- process), to minimal direct care, for example in
ness and independence. The exact nature of the the administration of regular injections.
supportive intervention will be determined by
the actual nature of the individuals need for The nurses role in illness
nursing, and the nursing situation. It can be
seen, therefore, that this cannot be prescribed The role of the nurse in illness is the tradition-
without reference to the individuals health ally predominant one. It is hardly surprising
status. Being cognizant of the concept of well- that for the majority of the public, and for many
ness and independence as values, the nurse can nurses, their model of a nurse is someone,
648 J . Minsliull ef al.

usually female, in a starched cap, engaged in the tool of assessment, individual needs being
performance of physical care. This is indeed a assessed in a hierarchical manner. It is acknowl-
large component of the supportive role of the edged within this model that the assessment of
nurse for the individual who is ill. In illness, it is Category 1 (physical) and Category 2 (safety
anticipated that the individual will have needs and security) must be carried out primarily as
he cannot completely meet himself, but often some unmet human needs in these two categor-
there is over-emphasis on the direct aspects of ies could be life threatening. Providing the nurse
care in supporting physical needs. is satisfied through the initial assessment that
The indirect aspects should share equal the patient is removed from immediate danger,
importance in supporting the individual at the each category of human need can then be
varying stages towards independence; in pro- explored with equivalent importance which, the
viding the environment in which the individual, authors suggest, permits a clear framework for
and those important to him, can explore the nurses of all levels to assess human needs in
implications of the altered health status; and the more intangible dimensions, i.e. personal/
providing support in the process of adaptation psychological.
required by all concerned, either in the short- Once the assessment is completed actual or
term, for example during an acute illness, or potential patient problems are then identified
longer-term as chronic illness. and put in order of priority. Problems at the
higher levels may well be more important for
Assessing individual needs the individual than those at lower levels and the
operational aspects of this model of nursing
Assessment is the foundation of the nursing facilitate the identification of such aspects. Not
process; unless the individuals needs for nurs- all individuals will have problems at all levels,
ing are deliberately sought, care can never be but all patients will have some problems in some
fully effective. Problems have arisen because levels.
nurses frequently have not had an overt model
of nursing from which to develop a framework
for assessment; therefore information is sought Nursing intervention
which may or may not be helpful in deciding the
nurses or patienticlients goals of care. An Nurses are beginning to see their patients as
example may be seen in the plethora of exten- partners in care; the passive patient role is now
sive nursing history forms which were printed at considered outdated and patients may need
the introduction of the nursing process, a educating in this change. As Gittins (1972)
decade ago. This invariably failed to fit into the wrote of the active participant role:
practitioners vision of nursing and therefore
the tendency has been to reject these out of He should be made to feel that he is not just a passive
piece of agonised and diseased flesh, to which and for
hand. The reasons for the necessity of an assess-
whom people do things, but that he has a part to play
ment tool may be seen as being to: in his own treatment and that some, at least. of the
responsibility devolves upon him.
1 provide a guide and a systematic approach;
2 identify priorities of information required; Nursings body of knowledge remains poorly
3 ensure that only relevant information which developed. By utilizing this model of nursing,
will be used is deliberately sought. thus the intuitive thoughts and feelings of nurses
acknowledging the individuals right to about the methods of supporting patients within
privacy: each category of need will be more readily
4 provide a basis for nurse and patient documented and available for analysis.
decision-making and goal setting; and
5 provide a focus for nurse and patient to
validate the existence of problems. Evaluation of the effectiveness of care

In interpreting this model for nursing prac- It is imperative to have some criteria by which
tice, the framework of human needs is used as a to measure the effectiveness of care. In the
The Human Needs Model of Nursing 649

immediate nurse-patient situation this is only is at an intuitive level, rather than that required
possible if goals are set following assessment. In by a practice discipline which is verified through
the wider domain, the model is suggested as a research. This model serves to identify areas in
suitable framework to evaluate the environment nursing of which we have little knowledge,
in which care is provided, both by practitioner especially of how the nurse may effectively
and manager. assess and meet human needs, particularly at
the higher levels.
It is therefore the intention of the authors to
CONCLUSION
continue the development of this model in order
It may be considered that the Human Needs that the translation of theory to practice can
Model of Nursing appears very simplistic. A occur, and the assessment tool to facilitate this
model may present over-simplifications of very is in the process of development. A nursing
complex relationships between concepts, and model should be capable of serving nursing
portray only the barest outline of the reality of practice, education and research; the authors
nursing (Clark 1982). Simplicity may be propose that the Human Needs Model of
defended, however, as being a requisite of a Nursing provides a basis for exploration and
model capable of being translated into multiple development in each of these spheres.
nursing situations, or as a starting point for
exploration of other models. It can be seen that References
the Human Needs Model of Nursing provides a
framework of discrete categories within the Atkinson J.W. et a / . (1954) The effect of experimental arousal on
the affiliation motive on thematic apperception. Journd qf
hierarchy equally emphasizing all aspects of Abnormal Social Psj1cholog.v 49,405.
human need as opposed to other models of Clark J. (1982) Development of models and theories on the con-
cept of nursing. Journal ofAdvanced Nursing 1, 129-1 34.
nursing referred to earlier (Henderson 1966, Fitzpatrick J.J. & Whall A.L. (1983) Conceptual Models qf
Roper er al. 1980). The Human Needs Model of Nursing: Ana!wis and Application. Brady, Bowie, Maryland.
Nursing overtly establishes that 25% of the Gillis L. (1972) Human Behaviour in Illness. Faber and Faber.
London.
nurses consideration should be given to Henderson V. (1961) Basic Principles of Nursing Care. Inter-
physical aspects with equal distribution of national Council of Nurses. London.
emphasis on the other three categories. This is Kasl S.V. & Cobb 5. (1966) Health hehaviour, ill behaviour.
Archives of Environmental Health 12,246261.
not to prejudge the percentage of care the indi- Maslow A.H. (1954) Motivarion and Personality. Harper and
vidual requires in each category but rather to Row, London.
Maslow, A.H. (1971) Mofivafion and Personality. 2nd edn.
ensure that each area of human need is fully Harper and Row, London.
assessed in order that patient problems can be McGlynn J. (1983) The unfolding of ideas. Nursing Mirror
given appropriate priority. January 12, 5&51.
Minshull J. (1978) The nursing process-the changing face of
It may also be argued that the Human Needs care. Unpublished DANS dissertation, University of
Model is untested in practice. This model is no Manchester.
less untested empirically than any other model Neuman B.M. &Young R.J. (1972) A model for teaching total
person approach to patient problems. Nursing Research 21,
at this stage in its development. A conceptual 264.
model provides a perspective, a way of looking Rogers C. (1980) A Way o f s e i n g . Houghton Mifflin, Boston.
Roper N. ef a/. (1983) A nursing model. Nursing Mirror May 2 5 ,
at something, in this case nursing. A model is 17-19.
also a representation of reality. The Human Roper N. ef a/. (1980) The Elements of Nursing. Churchill
Needs Model of Nursing is derived from the Livingstone, Edinburgh.
Schlotfeldt R.M. (1975) The need for a conceptual framework. In
reality of nursing as perceived by the authors. Nursing Research (Verhonick J . ed.). Little, Brown & Co..
Inherent within the model is an assumption of Boston.
the interpersonal nature of nursing based on the Smith L. (1982) Models of nursing as the basis for curriculum
development; some rationales and implications. Journal of
concept of partnership of nurse and patient/ Advanced Nursir:: 1,117-1 21.
client and of nursing as a process of deliberate South Manchester School of Nursing (1983) The philosophy of
nursing. Unpublished paper, South Manchester School of
action. The influence of nurse authors within Nursing.
the interpersonal dimension such as Travelbee, United Kingdom Central Council ( I 983) Statutory Insfrumenfs-
Henderson, Orlando, Wiedenbach, Orem and The Nurses, Midwives and Health Visitors Rules Approval
Order. HMSO, London.
Nightingale, cannot be ignored. Schlotfeldt WebbC(1984)On theeighthday Godcreatedthenursingprocess
(1975) suggests that present nursing knowledge and nobody rested. Senior Nurse 1(33),22-25.