Journal ofAdvanced Nursing,1986,11,643-649

The Human Needs Model of Nursing

Jean Minshull SRN SCM RCNT DN(Lon) DANS(Man) RNT Senior Tutor, Curriculum
Development, Kathryn Ross SRN OND SCM RCNT RNT Nurse Tutor, Curriculum Development
and Janet Turner SRN SCM RCNT DN(Lon) DANS(Man) RNT MSc(Man) Joint Appointee,
South Munchester School of Nursing, Munchester

Accepted for publication I4 January 1986

MINSHULL J., ROSS K. & TURNER J. (1986) Journal ofAdvancedNursing 11,643-649

The Human Needs Model of Nursing
Nurses in the United Kingdom spend much time attempting to fit British nursing practice into
the theoretical framework of American nursing models. This is often a manipulative process in
that it seeks to establish positive links with a care delivery system totally unlike our own. In the
present paper the authors detail the process of establishing a new nursing model which
integrates nursing curricula, education and practice to meet the needs of patients, staff and
students within their own health district. An over-emphasis on lower levels of human need is
common within nursing practice, which, although often blamed upon lack of human and
financial resources, is also due to practitioners misconceptions. The latter are invariably the
result of a lack of an adequate or overt, practice orientated, conceptual framework. The
Human Needs Model of Nursing adapts Maslows concept of human needs to create such a
conceptual framework for practice. It places equal emphasis on those patient problems which
arise as the result of unmet needs at higher levels as well as those at lower levels, thereby
acknowledging the holistic and dynamic nature of man.

NURSING MODELS nurse and thus a rejection of a medical model

Like most relatively new concepts, nursing
models are viewed with suspicion and scepticism
by the majority of nurses. The nursing process
initially suffered the same fate, being viewed as
implicit criticism of British methods of nursing
care delivery. The nursing profession may soon
be in the position where practitioners directly
involved in care delivery reject nursing models as
purely academic attempts at defining nursing
reality. This would mean losing valuable tools
which, when used effectively, provide nurses
with a realistic framework for their care delivery.
Over the past few years there has been an
increasing awareness of the unique role of the
Correspondence: J. Minshull, South Manchester School of
Nursing, Mauldeth House, Mauldeth Road West, Manchester
M212RL.
approach to both nursing practice and nurse
education. Nursing models are therefore begin-
ning to be utilized in the development of nursing
curricula but are not always being translated
into practice. A commitment (by the South
Manchester School of Nursing within our own
health district) to avoid this lack of professional
congruence in the process of translating curricu-
lum theory into the reality of nursing practice led
us to clearly determine the first two essential
steps in the re-writing of the registered general
nurse curriculum. These were seen as:
1 that a district philosophy of nursing be
determined; and
2 that nursing model(s) should be selected
upon which the curriculum could be based, in
agreement with Newman & Young (1972)

643
644 J . Minshull et a1
who state that the nursing model selected by
the school provides the conceptual basis.
needed unity, co-ordination and integration
for curriculum development.
In relation to establishing the philosophy, 14
structured group discussions took place within
the district to involve a one in ten representative
sample of nursing staff (including both trained
staff and students) in determining a statement of
beliefs and values about nursing and related
issues. In total 320 staff participated in this pro-
cess and the result was the formulation of the
South Manchester Philosophy of Nursing
(South Manchester School of Nursing 1983).
The authors then participated with other edu-
cational staff within the school of nursing in the
process of nursing model selection. The authors
believe that for nursing models to be effective in
influencing the quality of patient care delivery
they must be selected according to specifically
stated criteria. The authors identified the
following five criteria.
The philosophy of nursing of the district
should be reflected in the chosen model.
It should adequately meet the patient needs
\cithin the district. (These specific needs
encompass such things as the socioeconomic
status of the geographical catchment area,
the speed ofpatient turnover and the stage of
professional awareness of the caregivers.)
i t should be readily understood by all levels
ofnursing staff.
It should be translatable into nursing
practice.
Equal emphasis should be given to all aspects
of human needs.
Having established these criteria the authors
undertook a literature search for an appropriate
nursing model. Throughout the search the
following framework for analysing nursing
models was utilized (Fitzpatrick & Whall 1983).
1 Definition of the person, nursing. health.
environment.
2 Description of nursing activity.
3 Understanding of the person.
4 Understanding of health.
5 Inter-relationships among concepts of the
person, environment, health and nursing.
6 Description of the basic components
included in the model.
7 Relationships of basic concepts of the
person, environment, health and nursing.
A nursing model which met all the stated
criteria was not found. This was especially so in
relation to the stated requirement to place equal
emphasis on all aspects of human need. Some
commonly used models tend to concentrate on
the physical aspects of patient care, e.g.
Henderson (1966) directs 57% of the com-
ponents of basic nursing care towards physical
aspects, whilst Roper et al. (1980) devote 58% of
nursing activities to these aspects. In view of this
lack of major emphasis on other than physical
aspects of nursing care the authors decided to
create a new model of nursing which fulfilled the
stated criteria, and which could be utilized both
as a basis for curriculum development and also
for translation into nursing practice. The Human
Needs Model of Nursing was the result of this
process.
THE INDIVIDUAL
In defining the person within this model, the
philosophy of nursing of the health district was
utilized; this is based upon individual needs and
upon a humanistic approach to both nursing
and nurse education. A framework was then
sought within which human needs could readily
be described. Having completed the literature
search the authors accepted Maslows (1954)
theory of human needs as a means of describ-
ing man and adapted this as an integral part of
this model. In 1954 Maslow put forward a moti-
vational theory in relation to a hierarchy of
human needs which defined five levels of need,
i.e. physical, safety and security, love and
belongingness (within this model the terms love
and belongingness are replaced by the word
affiliation), dignity and self-esteem, and self-
actualization. He proposed that the individual
would only be motivated to meet higher needs
once the lower needs within the hierarchy were
met. This premise that one need level must be
met before other levels become important is
rejected within this model. (In the second
edition of his work, Maslow (1971) himself

FIGURE 1 The Human Needs Model
acknowledged that the hierarchy of human
needs was less clearly able to be defined than he
had previously thought.) An essential element
of the Human Needs Model of Nursing is that it
places equal emphasis upon each level of human
need. Further, the hierarchy is important in the
assessment of the individual in that physical
needs in the patient which are unmet may be life
threatening, as may unmet needs in the category
of safety and security.
There have been criticisms of the use of
Maslows ideas in nursing models (Webb 1984)
but this is largely due to either attempts by nurses
to apply Maslows motivational theory directly
to nursing care, or to its over-simplification by
authors such as Roper et al. (1983). Other criti-
cisms are related to the utilization of psychologi-
cal theories in the creation of nursing models,
but as McGlynn (1983) points out to construct
models of nursing which are acceptable,
theories must be generated or borrowed from
life sciences appropriate to the needs of patient
and nursing care.
An important factor which also influenced the
authors in the decision to utilize an adaption of
Maslows theory, was the experience of one of the
authors in applying this concept to direct indi-
vidualized patient care within the clinical area
where it proved extremely valuable (Minshull
1978).
The individual within this model is viewed
holistically, having interdependent physical,
The Human Needs Model of Nursing 645
of Nursing
psychological, spiritual and social needs. He is
viewed as unique, of intrinsic value, and the
centre of his own reality (Rogers 1980). The
authors have accepted five categories of human
need which have been adapted from Maslows
(1954) original work. Each of the categories
defined within the model is not intended to be
definitive but rather a descriptive example.
Unmet needs in the individual can lead to prob-
lems, and these problems are viewed as either
patient problems, because the individual is
aware of the unmet need, or nursing problems
because the individual is unaware of the unmet
need.
Category 1: physical needs
This is the first category of human need and
consists of those things which the individual
requires to maintain physiological homeostasis,
e.g. nutrition, elimination, heat and cold,
mobility, sleep and rest, light and darkness,
quietness and noise, hygiene, oxygen and car-
bon dioxide, sensory stimulation. Unmet needs
in this category result in patient problems which
could become immediately life threatening if
ignored, e.g. airway obstruction, as well as such
things as hunger, dehydration, constipation,
etc. Sensory needs are also included in this cate-
gory which, although not vital to physiological
646 J . Minshull et al.
homeostasis, cannot be ignored if the individual
is to be viewed holistically.
Category 2: safety and security
Included in this category of need are those things
which create a safe, orderly, predictable, lawful
and organized life. Examples of means of par-
tially fulfilling these needs are such things as
routine, rhythm and familiar and stable sur-
roundings, whereas needs for financial and social
stability are met by being able to work and thus
feel a contributing member of society. The need
to be free from fear is vital to psychological
security and unmet needs in this category can
lead to problems of anxiety. disorientation and
abnormal behaviour.
Category 3: affiliation needs
This category includes the more intangible
needs; namely the concern with the establish-
ment and maintenance of positive affectionate
relationships with other persons and with the
desire to be liked and respected (Atkinson et al.
1954). Hence the need for meaningful others -
for family, friends, children. colleagues, pets,
group and societal membership and, in par-
ticular, the need to have contact and to give
and receive love. Unmet needs in this category
result in loneliness, rejection, friendlessness,
rootlessness and alienation.
Category 4: dignity and self-esteem
These needs are related to independence and
individual achievement, as Maslow (1971)
states.
All people in our society (with a few pathological
exceptions) have a need or desire for a stable, firmly
based. usually high evaluation of themselves. for self-
respect or self-esteem. and for the esteem of others.
These needs may therefore be classified in two sub-
sidiar! sets. These are first, the desire for strength, for
achievement, for adequacy. for mastery and compe-
tence. for confidence in the face of the world and for
independence and freedom. Second, we have what
we may call the desire for reputation or prestige
(defining it as a respect or esteem from other people),
status, fame and glory, dominance, recognition.
attention, importance, dignity, or appreciation.
Another important aspect of this category is the
need for privacy and an involvement in
decision-making processes about oneself o r
meaningful others. Unmet needs in this cate-
gory lead to feelings of inadequacy, worth-
lessness, dependence, loss of motivation and
degradation.
Category 5 self-actualization
This category of human need is viewed as the
individual reaching their full potential. Maslow
(1 971) defined self-actualization as experienc-
ing fully, visibly, selflessly, with full concen-
tration and total absorption. However, as
Maslow himself pointed out, it is likely that
only a small proportion of individuals enter this
dimension for any substantial amount of time,
and that even these may only experience this
state transiently. It is accepted within the model
that although the nurse cannot directly meet
needs in this category that where all other cate-
gories of human need are met the individual
can be left free to explore the self-actualizing
dimensions of his illnessilife.
THE LIFE CONTINUUM
For the purpose of this model, life is conceptual-
ized as a continuum ranging from maximal
wellness, which equates with independence, to
maximal illness which equates with dependence.
This continuum can be seen to be both quanti-
tative in relation to the nurses perspective and
qualitative in relation to the patient; in that the
nurse will be involved in quantifying that which
the patient expresses or manifests (in terms of
clinical features, etc.) whereas the patient will
describe the situation or illness from a subjec-
tive viewpoint. That is not to say that either per-
spective is exclusive but rather to demonstrate
an awareness of the possible tangential views of
the patient situation. The individual is conceptu-
ally represented along this continuum within
the framework of a triangle. O n the wellness
side of the continuum the triangle is upright,
representing the individual in a relatively stable

state. On the illness side of the continuum the
triangle is inverted and thus is unstable, requir-
ing the support of the nurse in the appropriate
category in order to become relatively stable.
Within this model the authors accept Kasle &
Cobbs (1966) definitions of wellness and illness,
which are: wellness -when the individual per-
ceives himself or herself to be healthy for the
purpose of maintaining health and preventing
illness; illness -an activity undertaken by a
person who believes himself or herself to be ill
for the purpose of diagnosing a condition and
discovering a cure.
The individual (represented by the stable or
unstable triangle) can conceptually be placed
anywhere along the continuum depending upon
their health status. It is also postulated by the
authors that even within wellness individuals can
become relatively dependent on nursing support
whilst remaining well, e.g. a blind diabetic
person in the community requiring direct support
from the nurse. Whilst on the illness side of the
continuum, an individual may remain indepen-
dent whilst also being removed from a state of
wellness, e.g. the individual being admitted for
planned surgery who can be seen to be ill but
independent.
THE NURSE
Clark (1982) makes the critical point that most
nursing models assume a sick patient whereas
many nurses nurse individuals who are well.
Thus, to develop a model which is considered
capable of application to various situations
where student nurses learn to integrate theory
and practice and develop an understanding of
the nurses role, emphasis on that role in both
health and illness is paramount. The nurses
role within this model is viewed as a supportive
one; support being provided either directly or
indirectly in enabling or helping the individual
to meet their needs to achieve maximal well-
ness and independence. The exact nature of the
supportive intervention will be determined by
the actual nature of the individuals need for
nursing, and the nursing situation. It can be
seen, therefore, that this cannot be prescribed
without reference to the individuals health
status. Being cognizant of the concept of well-
ness and independence as values, the nurse can
The Human Needs Model of Nursing 641
only support the individual if she has ascer-
tained the meaning of the situation and experi-
ences for that individual. It is remembered that
an unmet need becomes a problem, one which
may not be perceived by the individual; perhaps
due to a lack of specialist knowledge, the very
nature of the illness, or because the individual is
so ill that he is unaware of many needs at differ-
ing levels. The unique function of the nurse is to
identify individual problems related to human
needs in order to plan and deliver nursing care
which will provide support in those categories
of need where the patient is unable to remain
independent. The accuracy of the assessments
made and the effectiveness of the care subse-
quently planned must be evaluated.
The nurses role in wellness
The support provided by a nurse when a person
is in a state of wellness may be viewed as being
predominantly indirect in nature, that is in the
promotion of health and the prevention of ill-
ness. These considerations underpin the first
two competenciesrequired of a registered general
nurse (United Kingdom Central Council 1983),
namely to:
1 advise on the promotion of health and the
prevention of illness; and
2 recognize situations that may be detrimental
to the health and well being of the individual.
This is not to suggest that these are not essential
components of all nursing situations, rather
that here there is emphasis placed on the indi-
vidual who is able, predominantly, to meet his
needs unaided. Thus the nurse aims to support
the person in maintaining a state of health and
wellness. Actions may be seen as ranging from
the provision of information to enable indi-
viduals to make informed decisions (including
support during and after the decision-making
process), to minimal direct care, for example in
the administration of regular injections.
The nurses role in illness
The role of the nurse in illness is the tradition-
ally predominant one. It is hardly surprising
that for the majority of the public, and for many
nurses, their model of a nurse is someone,
648 J . Minsliull ef al.
usually female, in a starched cap, engaged in the
performance of physical care. This is indeed a
large component of the supportive role of the
nurse for the individual who is ill. In illness, it is
anticipated that the individual will have needs
he cannot completely meet himself, but often
there is over-emphasis on the direct aspects of
care in supporting physical needs.
The indirect aspects should share equal
importance in supporting the individual at the
varying stages towards independence; in pro-
viding the environment in which the individual,
and those important to him, can explore the
implications of the altered health status; and
providing support in the process of adaptation
required by all concerned, either in the short-
term, for example during an acute illness, or
longer-term as chronic illness.
Assessing individual needs
Assessment is the foundation of the nursing
process; unless the individuals needs for nurs-
ing are deliberately sought, care can never be
fully effective. Problems have arisen because
nurses frequently have not had an overt model
of nursing from which to develop a framework
for assessment; therefore information is sought
which may or may not be helpful in deciding the
nurses or patienticlients goals of care. An
example may be seen in the plethora of exten-
sive nursing history forms which were printed at
the introduction of the nursing process, a
decade ago. This invariably failed to fit into the
practitioners vision of nursing and therefore
the tendency has been to reject these out of
hand. The reasons for the necessity of an assess-
ment tool may be seen as being to:
1 provide a guide and a systematic approach;
2 identify priorities of information required;
3 ensure that only relevant information which
will be used is deliberately sought. thus
acknowledging the individuals right to
privacy:
4 provide a basis for nurse and patient
decision-making and goal setting; and
5 provide a focus for nurse and patient to
validate the existence of problems.
In interpreting this model for nursing prac-
tice, the framework of human needs is used as a
tool of assessment, individual needs being
assessed in a hierarchical manner. It is acknowl-
edged within this model that the assessment of
Category 1 (physical) and Category 2 (safety
and security) must be carried out primarily as
some unmet human needs in these two categor-
ies could be life threatening. Providing the nurse
is satisfied through the initial assessment that
the patient is removed from immediate danger,
each category of human need can then be
explored with equivalent importance which, the
authors suggest, permits a clear framework for
nurses of all levels to assess human needs in
the more intangible dimensions, i.e. personal/
psychological.
Once the assessment is completed actual or
potential patient problems are then identified
and put in order of priority. Problems at the
higher levels may well be more important for
the individual than those at lower levels and the
operational aspects of this model of nursing
facilitate the identification of such aspects. Not
all individuals will have problems at all levels,
but all patients will have some problems in some
levels.
Nursing intervention
Nurses are beginning to see their patients as
partners in care; the passive patient role is now
considered outdated and patients may need
educating in this change. As Gittins (1972)
wrote of the active participant role:
He should be made to feel that he is not just a passive
piece of agonised and diseased flesh, to which and for
whom people do things, but that he has a part to play
in his own treatment and that some, at least. of the
responsibility devolves upon him.
Nursings body of knowledge remains poorly
developed. By utilizing this model of nursing,
the intuitive thoughts and feelings of nurses
about the methods of supporting patients within
each category of need will be more readily
documented and available for analysis.
Evaluation of the effectiveness of care
It is imperative to have some criteria by which
to measure the effectiveness of care. In the

immediate nurse-patient situation this is only
possible if goals are set following assessment. In
the wider domain, the model is suggested as a
suitable framework to evaluate the environment
in which care is provided, both by practitioner
and manager.
CONCLUSION
It may be considered that the Human Needs
Model of Nursing appears very simplistic. A
model may present over-simplifications of very
complex relationships between concepts, and
portray only the barest outline of the reality of
nursing (Clark 1982). Simplicity may be
defended, however, as being a requisite of a
model capable of being translated into multiple
nursing situations, or as a starting point for
exploration of other models. It can be seen that
the Human Needs Model of Nursing provides a
framework of discrete categories within the
hierarchy equally emphasizing all aspects of
human need as opposed to other models of
nursing referred to earlier (Henderson 1966,
Roper er al. 1980). The Human Needs Model of
Nursing overtly establishes that 25% of the
nurses consideration should be given to
physical aspects with equal distribution of
emphasis on the other three categories. This is
not to prejudge the percentage of care the indi-
vidual requires in each category but rather to
ensure that each area of human need is fully
assessed in order that patient problems can be
given appropriate priority.
It may also be argued that the Human Needs
Model is untested in practice. This model is no
less untested empirically than any other model
at this stage in its development. A conceptual
model provides a perspective, a way of looking
at something, in this case nursing. A model is
also a representation of reality. The Human
Needs Model of Nursing is derived from the
reality of nursing as perceived by the authors.
Inherent within the model is an assumption of
the interpersonal nature of nursing based on the
concept of partnership of nurse and patient/
client and of nursing as a process of deliberate
action. The influence of nurse authors within
the interpersonal dimension such as Travelbee,
Henderson, Orlando, Wiedenbach, Orem and
Nightingale, cannot be ignored. Schlotfeldt
(1975) suggests that present nursing knowledge
The Human Needs Model of Nursing 649
is at an intuitive level, rather than that required
by a practice discipline which is verified through
research. This model serves to identify areas in
nursing of which we have little knowledge,
especially of how the nurse may effectively
assess and meet human needs, particularly at
the higher levels.
It is therefore the intention of the authors to
continue the development of this model in order
that the translation of theory to practice can
occur, and the assessment tool to facilitate this
is in the process of development. A nursing
model should be capable of serving nursing
practice, education and research; the authors
propose that the Human Needs Model of
Nursing provides a basis for exploration and
development in each of these spheres.
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