Applying Maslow's Hierarchy in Nursing
On this page
Direct answer
A patient who is hypoxic and also frightened about surgery is not a difficult priority: Maslow's hierarchy, published by Abraham Maslow in 1943, ranks human needs from physiological (air, water, food, elimination, rest) up through safety and security, love and belonging and self-esteem to self-actualisation, and Nursing borrows the bottom of that pyramid as the first claim on attention. Lower needs must be at least partly met before higher ones drive behaviour, so airway, breathing and circulation outrank anxiety, and anxiety outranks a family-communication problem. In the nursing process the hierarchy is the standard instrument for ranking nursing diagnoses, sequencing teaching and answering "which patient should the nurse see first?" questions.
What you must remember
- The five levels, bottom to top: physiological; safety and security; love and belonging; esteem; self-actualisation — Maslow later discussed cognitive, aesthetic and transcendence needs, but INC examinations test the classic five.
- Physiological first, ABC within it: oxygenation outranks nutrition, and an airway problem outranks a fluid problem.
- Safety is second: physical safety (falls, seizures, side-rails, call-bell within reach) and psychological security (predictability, finances) — why fall precautions precede discharge counselling.
- Actual beats potential: "impaired gas exchange" outranks "risk for impaired skin integrity"; risk diagnoses lead only when their consequence is imminent and nothing actual competes.
- Acute beats chronic: new chest pain outranks long-standing arthritis pain at the same level of the hierarchy.
- Unexpected beats expected: a sudden change in a known condition (new confusion in a hypertensive patient) elevates that patient's priority.
- Patient input counts: the patient's perceived needs shape the plan, but the nurse mediates when perception and physiology disagree.
Four patients, one nurse: ranking them
At 7 a.m. one nurse holds four patients: one whose oxygen saturation has drifted to 88 per cent; one with a postoperative pain score of 6 due for analgesia; one refusing meals since yesterday because nobody visits him; and one asking to see the medical social worker about job insecurity before discharge. Rank them: the desaturation is physiological and immediately life-threatening — first, with positioning, oxygen and reassessment. The pain is physiological too, but ventilation outranks comfort, so analgesia follows within minutes. The third patient looks like a belonging-level problem until you notice the meal refusal — a love-and-belonging deficit has manufactured a physiological one, so the nurse treats loneliness as the etiology and intake as the measured outcome. The employment worry is an esteem-and-security issue handled by referral, last and legitimately last. The lesson examiners reward: Maslow ranks needs, not people, and a higher-level problem that produces a lower-level deficit jumps the queue.
How the exam frames Maslow
Examiners rarely ask for the five levels by name; they hand you four options and ask which need the nurse addresses first. The reliable rules: physiological before psychosocial; airway before everything within physiological; actual before "risk for"; and any stem word like "new", "sudden" or "deteriorating" elevates that option. One classic trap pairs a psychological comfort task against a physiological monitoring task — comforting the family waits until the 15-minute reassessment is done. A viva favourite: Maslow's is a humanistic motivation theory from "A Theory of Human Motivation" (1943), borrowed by nursing — calling it a nursing theory costs the mark.
Frequently asked questions
Which need level does pain belong to?
Physiological — pain relief takes precedence over safety, belonging and esteem interventions unless an airway or circulation threat coexists.
A patient at risk of falls wants to attend group therapy. Which need prevails?
Safety and security — the injury risk outranks the belonging benefit until fall-prevention measures are in place.
Where did Maslow publish the hierarchy?
In "A Theory of Human Motivation", Psychological Review, 1943 — the classic five levels are the version nursing syllabi use.
Do "risk for" diagnoses ever outrank actual problems?
Rarely — actual problems lead; a risk diagnosis comes first only when its consequence is imminent and no actual problem competes.
Where does Maslow fit in the nursing process?
In planning — ranking nursing diagnoses, ordering interventions and sequencing patient education from survival needs upward.