Basic Needs and Comfort Measures
Objectives
 Define basic human needs
 Define: self-actualization, self-esteem, love, security,
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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
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 and Discomfort
 List some attributes that you might associate with discomfort
 Examples: pain, nausea, fear, hunger, thirst, dark, worry
 List some other examples
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
Abraham Maslow (1908 - 1970)
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
Basic Human Needs have the following characteristics
 The absence of a basic human need results in illness.
 The presence of basic human needs helps prevent illness or
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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.
Maslow’s Hierarchy of Needs
 Certain needs are more basic than others
 All people have the same needs all of the time, people
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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
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
Level 1: Physiologic Needs
 A need which must be met at least minimally to maintain life; the
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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.
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3.
4.
5.
Using hand hygiene and sterile techniques to prevent
infection
Using electrical equipment properly
Administering medications knowledgeabley
Using skill when moving and ambulating patients
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)
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
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.
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
Nursing Process
Assessment
Evaluation
Intervention
Diagnosis
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
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
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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
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
1.
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 Measures
 Provide quiet, clean, uncluttered environment
 Provide warmth or coolness as indicated
 Provide personal hygiene: keep patient clean and dry, linen
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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