Maslow's Hierarchy of Needs in Nursing: The 5 Levels and How Nurses Use Them

The five levels, from the base up

• Physiological needs: oxygen, circulation, water, food, elimination, temperature regulation, sleep and rest. These keep the body alive and come first.
• Safety and security: freedom from physical harm, a safe environment, protection from infection, and psychological security such as knowing what will happen next.
• Love and belonging: relationships, family, friendship, acceptance and feeling part of a group or community.
• Esteem: self-respect, confidence, independence, achievement, and recognition and respect from others.
• Self-actualisation: reaching one's full potential, personal growth and meaning.

Where the theory comes from

Abraham Maslow, an American psychologist, set out the hierarchy in his 1943 paper "A Theory of Human Motivation" and developed it in his 1954 book Motivation and Personality. He argued that people are motivated by unmet needs, and that when a more basic need is unmet it dominates attention until it is satisfied.

The four lower levels are often called deficiency needs, because their absence causes distress. Self-actualisation is called a growth need, because it is about developing rather than making up for a lack. Maslow did not intend the levels to be completely rigid: a person can be working on several needs at once, and a need does not have to be fully met before the next one matters.

How nurses use Maslow to prioritise care

The hierarchy gives nurses a simple rule for ranking problems: deal with threats to life and basic body function first, then threats to safety, then psychosocial needs. This matches the airway, breathing and circulation (ABC) approach, because oxygenation and circulation sit at the base of the pyramid.

In practice the nurse assesses all of a patient's needs, then orders the nursing diagnoses so that the most basic unmet need is addressed first. A patient who is short of breath needs their breathing assessed and supported before anything else is discussed. Once the patient is physiologically stable, the nurse turns to safety, such as fall prevention or infection control, and then to emotional and social needs.

Examples at each level

• Physiological: maintaining a clear airway, giving oxygen as prescribed, managing pain that prevents sleep, monitoring fluid intake and output.
• Safety: keeping the call bell in reach, using bed rails where policy allows, hand hygiene, explaining a procedure before starting it.
• Love and belonging: arranging family visits, involving relatives in care planning, giving a lonely patient time to talk.
• Esteem: encouraging independence in personal care, respecting privacy and dignity, praising progress in rehabilitation.
• Self-actualisation: supporting a patient to set personal goals, such as returning to work or a hobby after illness.

Applying it to priority questions

Priority questions ask which patient, need or action comes first. Work through the options and label each with its level in the hierarchy; the option at the lowest level is usually the priority. A physiological problem that is actually happening, such as difficulty breathing, outranks a safety risk. A real safety risk, such as a confused patient trying to climb out of bed, outranks loneliness or concerns about self-image.

Two cautions help. First, an actual problem usually outranks a potential one at the same level. Second, read for urgency: a minor physiological complaint is not automatically more important than an immediate danger to safety, so use clinical judgement alongside the hierarchy.

Limitations of the hierarchy

Maslow's model is a guide, not a law. Research has not shown that needs are always met in strict order, and people in many cultures place family and community needs above individual esteem. Patients may also choose to put a higher need first, for example a dying patient who wants to see family rather than eat. Nurses use the hierarchy to structure their thinking while respecting each patient's values and choices.