the human needs approach, a basic handbook for nursing students

8/20/2019 The Human Needs Approach, A Basic Handbook for Nursing Students

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The Human Needs Approach

Data gathering AssessmenttoolWith possible nursing

diagnoses


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Compiled by

Ecaroh Smailliw RN

Introduction/foreword

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It is with the challenges that I had has a student nurse and

the current challenges student nurses are experiencing,

that I have decided to compile this assessment booklet

under the various needs.

This booklet was compiled with the intention of assisting

student nurses to assess their patients under the various

needs as adopted from psychologist Abraham Maslows

!"#$%&"#'$( theory of hierarchy of needs. It is hoped that

student nurses will use this guideline to not only carefully

assess their patients under the respective need, but that it

will also greatly assist them to formulate the correct

diagnoses based on their data collection.

It is anticipated that with correct assessment and nursing

diagnoses, that improved/optimal patient care will follow.

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)lease be reminded that this is *ust a basic guideline to

assessing client under the various needs and is not a

textbook or the bible to nursing assessment.

Objectives

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At the end of this session students will be able to+

". escribe the Methods of data gathering

-. xplain The human eed Approach undera. )hysical eeds

b. )sychosocial eeds

Methods of data gathering

Assessment involves the gathering of all possible data

regarding patients, to identify problems. The data

gathering methods include+ ". Interviews, -. 0bservation,

1. )hysical assessment, 2. 3onsultation with other

members of the health care team through records/reports

related to the patient as well as through verbal interaction

and 4. 5eview of literature.

ata are gathered essentially through five sources+ !"(The patient6 !-( 7amily members, friends and associates6

!1( other members of the health care team6 !2( 5ecords of

the patients present and past health status6 and !4(

8ritten information regarding the problem or problems

and treatment facing the patient.

The Human Needs Approach in gathering data

This system for data gathering is based on organi9ing data

around human needs. It is used most often by those who

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approach nursing with the ob*ective of meeting human

needs or preventing interference with the meeting of those

needs. The physical needs are identified separately and

the psychosocial are grouped together.

Physical Needs

1 Activity: This aspect of data gathering looks at the

patients ability to move and exercise for optimal

functioning. :ou look at the patients usual exercise

pattern at home, iversional choices and the effects

of exercise. Any recent variation from the norm,

such as *oint or muscle pain or disability, is of

importance. The individuals posture and

positioning and the level of activity prescribed by

the physician are other items of concern. ote the pathophysiology of bones, *oints and muscles, as

well as the use of tractions, bedboards or assistive

devices. Assess extremities for movement,

sensation, colour and warmth. ote also any

medication given that has a relation to this area.

Possible Nursing !iagnoses

Activity Intolerance related to an imbalance between

oxygen supply and demand

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Impaired physical mobility related to use of

traction/muscle atrophy/muscle

degeneration/fracture/pain/immobili9ation/prolonged

bed rest/muscle stiffness/loss of limb !s(/impaired

circulation.

Impaired walking related to !see above(

7atigue related to an imbalance between oxygen

supply and demand

Impaired bed mobility see related factor for impaired physical mobility

• Impaired wheelchair mobility see related factor for

impaired physical mobility

" Circulation: 3ollection of data under this category

looks at the delivery of nutrients and oxygen to thecells and the removal of waste from those cells.

0b*ective data includes pulse, blood pressure,

colour and warmth of the skin. Medication taken

for heart, blood pressure or other cardiovascular

situations. Any other signs and symptoms relating

to cardiovascular problems, including lab anddiagnostic tests, for example, haemoglobin,

haematocrit and blood chemistry levels.

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uring your interview, you should try and

ascertain from patient or significant other any

history or perception of any cardiovascular

problems and the medications that were ordered.

Identification of possible cardiovascular risk

factors should also be noted, such as smoking,

hypertension, diabetes mellitus, obesity and

lack/inade;uate exercise.


• Ineffective )eripheral Tissue )erfusion related to

decreased oxygen carrying capacity/high&low blood

pressure

• 5isk for ecreased 3ardiac Tissue )erfusion related

to decreased cardiac output

• 5isk for Ineffective 3erebral Tissue )erfusion related

neurological impairment/unconsciousness/increased

intracranial pressure

• 5isk for Ineffective hock

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)lease note that nursing diagnoses such as Ineffective

=reathing )attern, Impaired


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ote p and specific gravity of urine as well as

urinary pathophysiology and any medication taken

for urinary problems, noting any problems with

incontinence.


•

iarrhoea related to increased gastrointestinalmotility

• 3onstipation related decreased peristaltic action

• =owel Incontinence

• )erceived constipation

• ysfunctional


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respiration that are not related to exertion and also

for changes in cardiac rate and rhythm that are not

due to heart disease. An alteration in the amount of

fluid present in the tissues maybe demonstrated by

poor skin turgor or oedema as well an observation

of daily weight. ote serum electrolyte levels and

any medication given that could affect fluid and

electrolyte balance.


• eficient 7luid Bolume related to insufficient

intake/excessive loss

• xcess 7luid Bolume related to antidiuretic

therapy/accumulation/stasis within tissues• 5isk for electrolyte imbalance related to diuretic

therapy/excessive losses/medication therapy

• 5isk for Imbalanced 7luid Bolume

$ Nutrition: This aspect of data gathering looks at

getting nutrients into the body. :ou should observe

the patients eating habits !the amount of food

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taken and the kinds of food preferred(. Ask about

food likes and dislikes and the amount of fiber as

well as any dietary modifications in regard to food

intake. 3onsider the patients knowledge of proper

nutrition and understanding of any special dietary

restrictions. 3onsider as well what are the clients

ideal body weight, as well as weight gain and

weight loss that may be significant to nutritional

data. Assess for presence of )0 status, clients

ability to swallow, impaired respirations, ability to

feed self, disease states that increase or decrease

metabolic needs, any medication that may alter or

increase appetite.

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• Imbalanced utrition+ Cess than body re;uirement

•Imbalanced utrition+ More than body re;uirement

• Impaired >wallowing

• Ineffective Infant 7eeding )attern

% Oxygenation+ This need looks at all data concerned

with getting oxygen into the lungs and carbon

dioxide out of the lungs. :ou need to gather

information on breathing patterns and changes in breathing patterns. These include observation of

chest symmetry and of rate, depth and rhythm of

respiration. :ou should ascultate lungs for

abnormal/normal sounds, check breath sounds, and

look for indications of impaired airway and for

signs and symptoms or difficulty in respirations.

ote patients need for oxygen. :ou should also

note whether the patient coughs, type of cough,

whether it is productive or non productive.

8hether suctioning is being applied and the type of

medication the patient is on as well as noting any

disease states, e.g. eart disease.

5isk factors such as smoking should also be noted.

It has been proven that smoking is a risk factor

along with exposure to pollutants in the air. >ome

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work settings predispose the person to an increased

risk for respiratory problems. A history of fre;uent

colds or upper respiratory infections should also be

listed as a risk factor.


• Impaired hock

• 5isk for =leeding

• ecreased 3ardiac 0utput

• Ineffective Tissue )erfusion

& Protection rom !nection/"aety: These data looks

at the effect of the total environment on the patient.

:ou need to consider the environment both in terms

of the patients ability to respond to it and in terms

of safety from microbes for the patient and others.

ata that should be included are the care of

e;uipment, the positioning of bed rails, proceduresfor hand washing and the provision of isolation.

0ther factors that you need to consider are room

temperature, cleanliness, drafts, lighting and noise.

:ou should note if the client can reach bell, the

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impact of patient on other patient, the location of

the patient in relation to the nurses station.

The ability to communicate is also another

important factor in terms of patient safety.


• 5isk for Infection

• 5isk for In*ury

• Impaired Berbal 3ommunication

• 5isk for 7alls

• 5isk for Imbalanced =ody Temperature

• Ineffective Thermoregulation

• ypothermia

• yperthermia

• Impaired >kin Integrity

' #egulation and "ensation /Comort: This section

of the data collection looks at all the characteristics

associated with both the central nervous system

and the autonomic nervous system, including the

special senses and pain. It also looks at levels or

states of consciousness. >pecial senses include

visual and auditory acuity or lack of it. The pain

component includes the nature of the pain and its

location, duration, the patients perception of its

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intensity, the pathophysiology, the length of time

pain has been present and all the medication used

to control same. >ometimes it is more useful to list

pain under another assessment area&when it is

known to relate to a specific problem. =e sure

pathophysiology, and any related observations

made are in included.

The patient could be asked to read a book, a name

tag/identification bracelet, you can also en;uire

about the wearing of glasses. The clients hearing

may be checked by noting his/her response to your

;uestion and comments6 this can be best tested by

standing beside or behind the client.


• Impaired 3omfort

• Acute )ain

• 3hronic )ain

• ausea

• isturbed >ensory )erception !This can also be used

as a safety and security diagnosis(

( #est and "lee$: This aspect of data collection

looks at the patients normal sleep and rest patterns

and how hospitali9ation or illness may have

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affected them. :ou will need to look at the patients

appearance, does he/she appears to be tired/rested,

what amount of sleep is normal for that patient,

what is the usual bedtime, does he/she use sleep

aids or any other e;uipmentD The patients physical

and psychological status is important6 identify

factors that might be interfering with the amount

and/or ;uality of sleep. Identify factors such as

pain, e;uipment !noise, interference with comfortor positioning(, you should also consider the

clients diagnosis and its relationship in terms of

extra sleep and rest periods.


•

Insomnia• isturbed >leep )attern

• >leep eprivation

1) "%in !ntegrity &"aety'/Hygiene: This section

looks at the condition of the skin, its turgor,

hydration, colour, lesions, wounds, rashes, scars,tattoos, in*ection scars6 they should be noted, is the

skin outside of its normal continuity, is it raised, are

there breakagesD, these are some of the ;uestions

that should be asked. :ou should also list any

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sensitivity to soaps or lotions. Castly, you should

include, hygienic needs, such as the hair, mouth

and nails.


Impaired >kin integrity

Impaired Integrity if breakage is beyond the

epidermis

>elf 3are eficit !both activity and safety(

Psychosocial Needs

This aspect of data gathering can be very complex and has

several parts, such as growth and development, mental

health, sexuality, values and beliefs and >ociocultural

beliefs.

". (ro)t* and +evelo$ment: ach individuals life

stage reflects that individuals stage of

development. To understand this stage you should

look at the persons age, gender, occupation, and

role in the family. A very good example is a 1$year

old man who has a full time *ob, woman and atleast two children, his response to hospitali9ation

will be in contrast to a E4year old retired woman

who lives alone, and their adaption to illness will

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be different. It is important that you note peoples

perception related to their stage in life.

-. "el,Esteem/-ove and Belonging: :ou should look

for behaviour and record any statements that may

indicate how the patients feel about themselves and

their own life situations. 8hat kind of family

support does the patient have, is it accessible, is it

available at home, will the patient have visitorsD

oes the patient make statements about significant

others, their feelings about them and the type of

support they offerD ow does the client and

significant others interactD :ou should also note,

eye contact, tone of voice, affect and level of

anxiety.

1. "exuality: :ou need to gather information about

sexual difficulties, menstruation and menopause.

:ou should also make a note of all the medications

that are being used or any diseased state that could

have an effect on the clients sexuality.

It is of paramount importance to gather all

information about sexuality when the person has

had an illness or surgery that affects the

reproductive or gynaecology, breast, or urinary

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systems. The patient may indicate to you that there

are problems with sexual performance. >exuality is

a very sensitive area for most people, so you need

to be careful how you go about asking ;uestions as

they relate to this area, because you may come

across as prying.

2. "ociocultural: ach person should be assessed

within the context of their ethnic/cultural

framework and the impact it may have on illness

and hospitali9ation. 0ther ;uestions that you will

need to ask your self are+ is the patient able to

speak or understand nglish language, will the

general care customs, dietary

preferences/restrictions and/or religious practices

affect the care of the client. 8hat are the

expectations of the family in the care of their

significant others, can they take food, can they visit

in large numbers, can they assist in taking care of

the patients, how will this affect the patients status,

*ob, role in the familyD

4. alues and Belies: These may be based on an

organi9ed religion or on a general philosophical

system. ?indly note any religious affiliation noted

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on the patients admission form. :ou could ask the

patient if he/she want a religious advisor, pastor or

church to be notified. 0bserve all

religious/philosophical reading materials and

conversations. 3onsult with the hospitals chaplain

if there is one, about any written or any other

religious material with which you are not familiar,

or you could simply ask the patent if you could

help.Possible Nursing !iagnoses

• >exual ysfunction

• Ineffective >exuality )attern

• Anxiety

•

7ear • =ody Image isturbance

• Ineffective 3oping

• 3ompromised 7amily 3oping

• elf steem

• >ituational Cow >elf steem

• opelessness

• Adult 7ailure to thrive

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• )owerlessness

• Ineffective enial

• Interrupted 7amily )rocess

• Moral istress

• Impaired 5eligiosity

• >piritual istress

5eferences

llis, F., owliss, .,G =ent9, M. ). Modules for basic

nursing skills. !-$$$(. 8ashington+

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Cippincott 8illiams G 8ilkins

t. Couis, Missouri+ lsevier Mosby

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