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Maslow’s Hierarchy of Needs by Bob Poston, cst An Exercise in Personal Exploration: Maslow’s Hierarchy of needs is a valuable assessment tool that is used in many different professions, particularly those in the fields of education and health care. the ideas of needs are addressed in order, as the body resolves the most basic needs for survival before moving on to more complex needs. M ny educational programs in the health care field teach Maslow’s hierarchy in order to address the needs of patients and where they are in their life from a psychological perspective, simply because it helps identify and address the needs of those particular patients. The idea of using a hierarchy pyramid helps us to lay out the stages of need, starting with the base of the pyramid, which looks at physiological needs. As we work our way up the pyramid, the needs start to become more complex, and include safety needs, social needs, esteem needs, and finally, at the very top, we have self-actualization.This article explores the theories of Abraham Maslow in detail, as well as addresses the controversies that have been questioned in his theory. This article will also evaluate the impact of these theories on human behavior and assess each of the components comprised within Maslow’s Hierarchy Pyramid. learning OBJec tives s identify the different levels of Maslow’s Hierarchy of needs s Compare and contrast the differences between being needs and deficit needs s explain the process of selfactualization s examine how Maslow’s Hierarchy of needs impacts patient careBiographical outline Born on April 1, 1908, in Brooklyn, New York, Abraham Maslow was the first of seven children. 1 The son of under-educated Jewish immigrants, Maslow didn’t have many friends as a young s Consider the challenges to Maslow’s theories and formulate a response  © 2009 Association of Surgical Technologists For reprint permission: [email  protected] org A UGUST 2009 | the surgical technologist | 347 food and play, they would in more cases choose the food. The same was true when it came to the monkeys’ choice between water and food.The water would always be chosen as the Selfpriority over food. Self-fulfullment actualization: needs achieving one’s As the observations continued, a full potential, pattern emerged. Maslow could see, on including creative a physiological level, that if the monactivities keys didn’t have food, but had water, Esteem needs: the group was less aggressive than prestige and feeling of accomplishment Psychological those that had the water taken away needs Belongingness and love needs: from them. 1 The same held true with intimate relationships, friends safety needs.If all of the physiologiSafety needs: cal needs were met, then the monkeys’ security, safety Basic behavior became more profound when needs Physiological needs: it came to establishing social roles and food, water, warmth, rest dominance. Maslow later transitioned this idea over to human behavior and was able to establish physiological needs over child, but found his sense of self by reading books. He safety needs, safety needs over belongingness needs, belongbegan his college journey by attending City College of New ingness needs over esteem needs, and esteem needs.The York, and later transferred to Cornell University, before needs, in turn, form the first four components of the pyragoing back to City College of New York. After realizing a mid, and are addressed as deficit needs. Self-actualization, keen interest in psychology, he moved to Wisconsin, where the fifth component, addresses the need of being, which he studied at the University of Wisconsin. Throughout defines one’s own place in the universe. the 1930s, Maslow earned his BA, MA and PhD. Later, When an individual does not have enough of something, he returned to New York, where he not only taught full he or she has a deficit, ultima tely creating what Maslow has time at Brooklyn College, but he also became interested in termed â€Å"deficit needs. †1 When individuals eat and drink, human sexuality. for example, the need for water and food is met, so there Maslow served as chair of the Department of Psy- is no longer a motivating factor to obtain water or food, chology at Brandeis from 1951-61. While there, he met and the deficit need has temporarily been satisfied. Deficit a well-established researcher named Kurt Goldstein, who needs comprise or make up the four lower components of developed the idea of â€Å"self-actualization. † This concept Maslow’s hierarchy pyramid. fascinated Maslow, and it was through this notion that he On the other hand, Maslow also mentions the idea of pursued the idea of humanistic psychology, which he ultiâ€Å"being needs. † Being needs have nothing to do with deficit mately valued more than his own research.Maslow died needs. Being needs are internal, a nd are at the very top of on June 8, 1970. 1 Maslow’s hierarchy pyramid, which ties into self-actualization. 2 An example here might be drawing one’s own conclucreating the hierarchy of needs sions of where and who he or she is spiritually. This internal Abraham Maslow is well known for the creation of the concept is addressed as self-actualization. hierarchy of needs. The way he came up with this idea The following sections of this article will address each was by studying and observing monkeys.During observalevel of Maslow’s Hierarchy of Needs in more detail in an tion, he noticed that they displayed a very unusual pattern effort to see how they apply to individuals, and how they of behavior that addressed priorities based on individual can define who and where an individual is in his or her life. needs. If, for example, the monkeys had a choice between FIGURE 1: MASLOW’S HIERARCHY PYRAMID 348 | the surgical technologist | AUGUST 2009  © 2009 Associat ion of Surgical Technologists For reprint permission: [email  protected] orgPHYSIOLOGICAL NEEDS With so many different capabilities, from the regulation of temperature and hormones to the processing of water, food and the elimination of waste, the living body is the most unique machine in the universe. Despite its relative fragility, the human body can live for many years. Every single detail is so integral, from how the body processes oxygen through millions and millions of tissue cells, to the thousands of miles of arteries that carry blood and nutrients to those tissues. With this being said, there is still the need to meet the very basic essentials of ife: the body must take on oxygen, water and food. Before any further growth can take place, this very basic need has to be met. This is what Maslow addresses as a physiological need—the need for the body to work in unison to accomplish the task of basic survival. Physiological needs are influenced generally through the cr avings that we have. If a person is thirsty, he or she finds a drinking fountain. Similarly, if the individual is hungry, he or she will find food. If the body is being deprived of oxygen, it will surely react. If there is a vitamin deficiency, the body has subtle ways of fulfilling that need.One example of how the body regulates itself on a physiological level is by homeostasis. Homeostasis simply means to regulate. A part of the human brain, called the hypothalamus, plays an important role in keeping the body regulated by controlling the body’s thermostat, which is controlled by the release of several hormones called gonadotropins. If a female produces too much estrogen, the hypothalamus releases a hormone called luteinizing hormone that triggers ovulation, therefore acting like a shut-off switch for the amount of estrogen present.If the thyroid gland produces too much thyroxin, the hypothalamus produces a hormone to switch off the flow of the thyroxin. These are Throughout life, the idea of physiological needs remains consistent. The need to maintain adequate physiological balance will always be essential†¦ just a few examples of homeostasis at work, however, there are many circulatory hormones that are needed to maintain normal bodily functions. Another prime example is the release of the â€Å"fight or flight† hormones that are secreted by the adrenal medulla of the adrenal glands.If there is a need for the body to defend itself, these hormones will surge into action to prepare the body for fight or flight. These hormones, although they play an important role, are kept in compliance by regulatory mechanisms within the brain. 3 Throughout life, the idea of physiological needs remains consistent. The need to maintain adequate physiological balance will always be essential, and may kick into action in very different ways at various different times, whether the individuals experiencing it are aware of it or not.For example, how would anyone ever get a good night’s sleep if they had to literally think about their breathing pattern, heart rate or blood pressure on a conscious level? Sure some people may have to get up during the night to use the restroom or grab a glass of water, but remember that this is all part of how the body regulates itself. The notion that physiological needs tie into other, more complex needs of the hierarchy is very relevant. Maslow The basic principles of Maslow’s hierarchy have been observed in primates.  © 2009 Association of Surgical Technologists For reprint permission: [email  protected] rg AUGUST 2009 | the surgical technologist | 349 Again, this need will change depending on where an individual is in his or her life. For a young child, approvalseeking behaviors may become more commonplace. The child may engage in activities to get his or her parents’ attention by exploring or asking lots of questions. In a sense, the child needs to feel an emotional or social co nnection with SAFET Y NEEDS his or her parents. As the child evolves into a teenager, he Much like physiological needs require maintenance throughout life, so does the need to feel secure.This need is or she will more than likely become more socially active in more psychological. With that being said, safety needs may peer groups. Generally, whatever gets reinforced, supported, be different for each individual, depending on where he or or accepted by these peer groups will often determine which type of group the adolescent will affiliate him or herself she is in life. For a child, this need may manifest as the need with. This idea can be noticed at any point throughout an individual’s life. Safety needs may be different for each individual, depending on As youths ature into adulthood, they tend to affiliate with those indiwhere he or she is in life. For a child, this need may manifest as viduals or groups who accept them. A sense or a need to belong, at any the need for a saf e family environment. There has to be security stage, is influenced by several factors. in the home, with warmth and love. Some of these influences, for example, are socio-economic influences: the education level of parents and family, 4 the neighborhood in which the child grows up and the type for a safe family environment.There has to be security in the home, with warmth and love. When a family is dysfunc- of schools where they are educated, as well as the children tional, it makes it difficult for that child to move up to the who attend those schools. Whatever type of behavior is learned and accepted, based on these variables, is likely the next level of social needs because fear is often present. For adults, this need may be economic in nature. If a behavior that will form a particular individual’s character person loses his or her job, for example, fear and anxiety and self-esteem.The level of belonging must be established because of its will have an impact on that perso n’s social life, and may effect on one’s self-esteem. If the level of belonging in the cause him or her to regress. 5 Additionally, adults are not hierarchy model is low, or an individual is viewed negatively immune to the need of safety. In some parts of the world, where there is chaos, people are stuck at this level of need- by peers in that group, he or she may develop social anxiety ing to feel safe. The goal of consistently meeting the need for and may withdraw toward a level of people in which he or safety is to have stability in one’s life.It is the idea of being she fits in socially. If a child grows up in a neighborhood able to walk around the block at night without the worry of where there are street gangs, and attends schools in that being mugged. It is the idea of feeling secure in the work- neighborhood with the families of those street gangs, then place. It is conclusive that fear hinders one’s ability to move the likelihood of the child to adapt and take on that form of character becomes more likely. According to Maslow, the on to the more advanced platforms of Maslow’s pyramid. eason for this behavioral pattern is likely due to the peer groups that the child grew up with. BELONGING NEEDS This is not meant to imply that all children who grow up Advancing up the hierarchy pyramid, the next level reprein this type of neighborhood will join a gang, simply that sents the need to belong on a social level. The social level generally becomes the priority only after the physiological there is a higher likelihood of that outcome. On the other and safety needs have been sufficiently met and maintained. and, if a child is brought up in a more affluent neighborhood, it is likely that the parents will also be more educated. A sense of belonging can be felt when an individual becomes more focused on the desire to build relationships with others. In this scenario, it is more likely that the child will develop This includes th e desire for a romantic partner, to have close and adapt to the peer groups in which education is more of a priority. The influence in a child’s upbringing starts friends, and maybe to get married and have children. 1 elieved that once the physiological needs are met in sufficient detail, people move on to address these more complex needs. Safety and security make up the next platform of the pyramid. 350 | the surgical technologist | AUGUST 2009  © 2009 Association of Surgical Technologists For reprint permission: [email  protected] org with a home and family that secures the previous levels of Maslow’s hierarchy by meeting and maintaining the foundation levels of needs. Relieving any anxiety or fear will help put more emphasis on social development, and with this will come a healthier self-esteem.ESTEEM NEEDS Once the needs of physiology, safety and belonging have been met, the individual will now move on to the needs of their self-esteem. Self-esteem, like all th e prior needs, must also be maintained. This is the highest platform in the category of deficit needs. 1 The process of growth, when addressing one’s self-esteem, builds the bridge to one’s awareness. Self-esteem begins to establish itself in life as early as age two. Maslow’s hierarchy addresses two levels of self-esteem. One of those is a lower level and the other is a higher level.Maslow’s hierarchy is a two-way street. A person can spend a lifetime traveling between the two extremes. The lower form of self-esteem is directly related to an individual’s ego, meaning that there is a strong need to be respected by others. 4 Within this lower form, the individual still remains focused on acceptance by others. This lower form of self-esteem is met when an individual has established a level of status, recognition, fame, reputation and appreciation, just to name a few. These areas in a person’s life take work to maintain.They may also require so me reinforcement or validation of some kind in order for this lower form of self-esteem to be maintained. The higher form of self-esteem that Maslow addresses is that of self-respect. This higher form of self-esteem requires less maintenance because through accomplishment, it becomes a permanent part of who the individual is. We can say that once a person has gained respect for himself or herself, it is much harder to lose that respect or to have it taken away. People on the higher end of selfesteem generally like who they are.The idea of confidence in ability, the mastery of something, or the competence that is established in what these people do, supports this higher form of self-esteem. These forms of self-esteem should not be confused with an individual having high or low self-esteem. Individuals with low self-esteem often have a low opinion of themselves and their self-image. As a result, inferiority complexes are present in the individual. With this idea in mind, Maslow conten ds that the majority of people’s psychological problems are due to low self-esteem.The realism here is that if a person don’t like himself or herself, or who he or she is or what he or she has accomplished, then that person will be more critical of himself or herself. Through that process, negative self talk is born, and can create a barrier to achieving personal success. How does low self-esteem impact these lower and higher forms of selfesteem in general? If an individual has low self-esteem, the lower form of self-esteem affects the individual on a social level. The individual may, for example, constantly attempt to seek or validate feedback and acceptance on a social level from his or her peers.With regard to the higher form of selfesteem, in the individual with low selfesteem may display a lack of respect for himself or herself and the expectations that they place upon themselves would be unrealistic, or perhaps in some cases these expectations would be placed by others rather than being placed by the individuals themselves. It is amazing that all of the prior needs within Maslow’s hierarchy, including physiological, safety, and even belongingness needs are frequently met, especially in modern society and developed countries.Imagine if more people just had a little respect for themselves in the grand scheme of things.  © 2009 Association of Surgical Technologists For reprint permission: [email  protected] org AUGUST 2009 | the surgical technologist | 351 THE CONTROVERSY As we take a look at Abraham Maslow’s hierarchy pyramid, there is some controversy as to how it relates directly to humanistic psychology. Is there enough evidence to support this hierarchy when it comes right down to how people develop emotionally?Maslow set forth with the notion that these stages along Self-actualizers are focused on what matters most in defining the course of development match up with how people experience psychowho they are. Once self-re spect is gained, the individual can take logical growth. The primary contention is that a more proactive approach to bettering themselves, as well as anyone in society can regress back to, being able to remain focused on resolving any dilemmas †¦ or value an alternative aspect of the hierarchy pyramid in a way that is not parallel with Maslow’s model.For example, some cultures may be more fixated on belongto figure out, or it can be the determining factor of how well ing over safety, or esteem over belonging. 5 To answer these he or she is connected with his or her self and abilities. People who are self-actualizers are focused on what challenges, many experts believe that Abraham Maslow’s matters most in defining who they are. Once self-respect is hierarchy doesn’t always follow in sequence with how it gained, the individual can take a more proactive approach was intended.If the notion of self-esteem, for example, is thought to develop in children as early as two years of age, to bettering themselves, as well as being able to remain focused on resolving any dilemmas that may arise regarding then why does Maslow address esteem needs so high up in the deficit stages. Self-actualizers may be more generative in the hierarchy pyramid? Humanistic psychology does challenge some of these notions, even though Maslow was a the sense that the focus is no longer as much about pleasbeliever in humanistic psychology. ng others as it is giving back or sharing this part of who Another oft-challenged aspect of his work is that Maslow they are. 6 In other aspects, it can also appear to be spiritual. himself defined self-actualizers as people of great accomLooking at one’s life as to who he or she is in the universe is a good example. Once a person is able to come to terms plishment, such as former presidents, dignitaries and great discoverers. With that being said, it is very difficult to place with who they are, and they are ultimately satisfi ed with an emphasis on the concept of self-actualization.How sigthat, then they have truly reached the point of being able nificant is the concept of the self-actualizer? The only way to self-actualize. With this level of intuition comes a sense of peace, which that to answer that question is to say that all people are at in turn serves as a motivator to focus on more advanced different stages of development, and all of them are selftasks in life, such as supporting the moral and ethical stan- actualizers in some form. SELF-ACTUALIzATION Self-actualization is defined by Maslow as the single component of being within the hierarchy model.Being, in this sense, means not being a part of the deficit needs as they appear within the lower chain of the hierarchy. 1 This need is independent—there must be some accomplishment of all the other deficit needs, which are best defined as what we appear to be, according to the standards of society. Selfactualization is the internal dialogue t hat everyone establishes at some point in their lives. In order to do that, there must be some establishment or satisfaction of the prior needs. Once all of the previous needs have been met, an individual can direct his or her focus toward a true calling.Usually when a person is hungry, or they don’t feel safe, or they feel unloved, the focal point leans towards resolving those issues, therefore disrupting the focus on self-actualizing. With self-actualization, being able to pinpoint how one truly feels about something is often a little more challenging dards in life. There is a more in-depth focus on bettering oneself and expanding one’s knowledge and talents. The real definition to self-actualizing is getting to know oneself, while being okay and unconditionally accepting of whatever it is that he or she discovers.The question every individual must face is, do you like and accept who you are? Once that question is answered, then self-respect is gained. Once an indivi dual establishes that respect for his or herself, no one can take that away. In this context, Abraham Maslow is justified in establishing self-actualization in a category by itself that quantifies the need of being separately from the need of deficit. 352 | the surgical technologist | AUGUST 2009  © 2009 Association of Surgical Technologists For reprint permission: [email  protected] org verview When looking at Maslow’s hierarchy pyramid, an important concept to remember is that anyone at anytime can regress back to any point within the hierarchy structure that Maslow addresses. How does this impact human behavior? Looking back at the very basics of physiological needs for example, people need to feel good. It does not matter if a person is employed as a janitor or a top-notch cardiac surgeon, if he or she is diagnosed with a disease that impacts them physically, he or she is likely to regress back towards satisfying any physiological needs that may come about.The affecte d individual’s attitude towards the prognosis of this disease will likely contribute towards a shift in his or her priorities. Emotionally, the feelings of love and belonging may be impacted in the sense that they may want to ensure that their loved ones are safe when they pass. With regard to esteem, for some, there may be a great sense of loss, while others may come to terms with the fact. With that being said, there are circumstances that affect each individual with regard to where he or she stands in the hierarchy pyramid. Is everyone a self-actualizer? Yes. For each individual, this experience is different.It is experienced at different depths depending on individual life experiences. The more in touch one is with one’s inner self, the better he or she can control, and often master, one’s self-talk. It is also important to remember that all individuals are constantly impacted by the forces of life, some of which are far beyond personal control. When the opp ortunity arises to experience this hierarchy, and the needs of deficit are fully met, it allows the individual to make a closer connection with the concept of self-actualization. Also, when these deficit needs are met, self-actualization, in a sense, is likely to become even more enhanced.The bottom line is that everyone is effected emotionally at every level of Maslow’s Hierarchy of Needs. If early life experiences as a child are positive, and needs are being met, that individual will excel in the area of self-confidence and self-esteem at much faster rate. It helps to establish a strong foundation for life. Later, the individual is able to establish a much stronger set of coping mechanisms when one of the deficit needs isn’t being met. Additionally, when adverse circumstances confront the individual, he or she is often better-equipped with the ability to problem solve and confront the challenge confidently.Conversely, if early life experiences as a child are negative , and needs are not met, that individual’s foundation isn’t as secure, and he or she is not as likely to excel in selfconfidence and self-esteem, rather, he or she is likely to get trapped a state of constantly seeking approval from peers. He or she may develop a fear of making mistakes. The majority falls somewhere in between what is positive in life and what is negative. Ultimately, individuals who develop a strong, well-established foundation are likely to be emotionally strong and can exercise a stronger sense of self control.Those whose foundation is shaky and not very stable will focus more on protecting it, therefore having less confidence in that foundation. ABOUT THE AUTHOR Robert A Poston, cst has been a surgical technologist since 1993. He began his work in education with Concorde Career College in North Hollywood, California in 1997. He has been a guest speaker with the California State Assembly of Surgical Technologists in 2001 and 2003. Robert Poston is c urrently the Program Chair for Surgical Technology at Everest College in Thornton, Colorado. He has also served as an item writer for the National Certification Exam for Surgical Technology.RefeRences 1. Boeree, George C. â€Å"Abraham Maslow, 1908-1970. † Personality Theories. 2006. Available at: http://webspace. ship. edu/cgboer/maslow. html. Accessed 4/9/2009. 2. 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Accessed: 4/9/2009.  © 2009 Association of Surgical Technologists For reprint permission: [email  protected] org AUGUST 2009 | the surgical technologist | 353