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Lesson 1: Maslow's Hierarchy of Needs

Wednesday, September 02, 2020 9:52 PM

Intended Learning Outcome

At the end of the lesson, the student will be able to correlate the concepts of Maslow’s
Hierarchy of Needs to the practice of Pharmacy.

Introduction
Some people will do everything for fame and will do whatever it takes to have it. Some
people will do whatever it takes to be loved back by the person they love. Some people
will do whatever it takes even to commit crimes, just to feed their families.

Some people will leave the life they have known just to stay safe again. Some people
are just fine the way they are and simply keep on living on, inspired by the journey as
much as their destination. These people represent each of the five levels of Maslow’s
hierarchy of needs which was developed by Abraham Maslow.

Abraham Maslow, the American psychologist, is best known for his theory of hierarchy
of needs. Maslow’s theory highlights the positive potential of humankind and tries to
understand how motivating factors relate to individual behavior. The nature of these
factors is vital to pharmaceutical care as well.

Maslow presented the idea that human actions are directed toward goal attainment. Any
given behavior could satisfy several functions at the same time; for instance, going to a
bar could satisfy one’s needs for self-esteem and for social interaction.

In his influential paper of 1943, A Theory of Human Motivation, Abraham Maslow

proposed that healthy human beings have a certain number of needs, and that these
needs can be arranged in a hierarchy, with some needs (such as physiological and
safety needs) being more primitive or basic than others (such as social and ego needs).
Maslow’s so-called ‘hierarchy of needs’ is often presented as a five-level pyramid, with
higher needs coming into focus only once lower, more basic needs have been met.

Content/ concept

Abraham Maslow, in full Abraham Harold Maslow, also called Abraham H. Maslow,
an american psychologist and philosopher best known for his self-actualization theory of
psychology, which argued that the primary goal of psychotherapy should be the
integration of the self.

In his major works, Motivation and Personality (1954) and Toward a Psychology of
Being (1962), Maslow argued that each person has a hierarchy of needs that must be
satisfied, ranging from basic physiological requirements to love, esteem, and, finally,
self-actualization. This hierarchy suggests that people are motivated to fulfill basic
needs before moving on to other needs. As each need is satisfied, the next higher level

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in the emotional hierarchy dominates conscious functioning. Maslow believed that truly
healthy people were self-actualizers because they satisfied the highest psychological
needs, fully integrating the components of their personality, or self.

The lowest levels of the pyramid are made up of the most basic needs, while the more
complex needs are located at the top of the pyramids. Needs at the bottom of the
pyramid are basic physical requirements including the need for food, water, sleep, and
warmth. Once these lower-level needs have been met, people can move on to the next

Types of Needs
Maslow believed that these needs are similar to instincts and play a major role in
motivating behavior. Psychological, security, social, and esteem needs are deficiency
needs (also known as D-needs), meaning that these needs arise due to deprivation.
Satisfying these lower-level needs in important in order to avoid unpleasant feelings or
consequences.

Maslow called the bottom four levels of the pyramid ‘deficiency needs’ because we do
not feel anything if they are met but become anxious or distressed if they are not. Thus,
physiological needs such as eating, drinking, and sleeping are deficiency needs.

Maslow termed the highest-level of the pyramid as growth needs (also known as being
needs or B-needs). Growth needs do not stem from a lack of something, but rather from
a desire to grow as a person.

Maslow referred to self-actualization as a “growth need,” and he separated it from the

lower four levels on his hierarchy, which he called “deficiency needs.” According to his
theory, if you fail to meet your deficiency needs, you’ll experience harmful or unpleasant
results. Conditions ranging from illness and starvation up through loneliness and self-
doubt are the byproducts of unmet deficiency needs. By contrast, self-actualization
needs can make you happier, but you are not harmed when these needs go unfulfilled.
Thus, self-actualization needs only become a priority when the other four foundational
needs are met.

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Five Levels of the Hierarchy of Needs

1. Psychological Needs
• These are the basic needs that are vital for survival. Such as, the need for water,
air, food, and sleep. Maslow believed that these needs are the most basic and
instinctive needs in the hierarchy because all needs become secondary until these
physiological needs are met.

In addition to the basic requirements of nutrition, air and temperature regulation,

the physiological needs also include such things as shelter and clothing. Maslow
also included sexual reproduction in this level of the hierarchy of needs since it is
essential to the survival and propagation of the species.

2. Security and Safety Needs

• As we move up to the second level of Maslow’s hierarchy of needs, the
requirements start to become a bit more complex. At this level, the needs for
security and safety become primary.

When the physical needs are relatively satisfied, the individuals safety needs take
over and dominate their behavior.

People want control and order in their lives. So, this need for safety and security
contributes largely to behaviors at this level. Needs related to people’s yearning for
predictability, orderly world in which injustice and inconsistency are under control,
the familiar frequent and the unfamiliar rare.

Some of the basic security and safety needs include:

○ Personal security
○ Financial security
○ Health and wellness
○ Safety against accidents or illnesses

Security needs are important for survival, but they are not as demanding as the
physiological needs. The desire for steady employment, health insurance, safe
neighborhoods, and shelter from the environment are some examples of security
needs.
Together, the safety and physiological levels of the hierarchy make up what is often
referred to as the basic needs.

3. Social Needs

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• The social needs in Maslow’s hierarchy include such things as love, acceptance,
and belonging. At this level, the need for emotional relationships drives human
behavior. The social needs on the third level of Maslow’s hierarchy relate to human
interaction and are the last of the so-called lower needs.
Some of the things that satisfy these social needs include:
○ Friendships
○ Romantic attachments
○ Intimacy
○ Social and community groups
○ Supportive and communicative family
○ Churches and religious organizations

Maslow considered these needs to be less basic than physiological and security
needs. In order to avoid problems such as loneliness, depression, and anxiety, it is
important for people to feel loved and accepted by other people. Personal
relationships with friends, family, and lovers play an important role, as does
involvement in other groups that might include religious groups, sports teams, book
clubs, and other group activities.

4. Esteem Needs
• At the fourth level in Maslow’s hierarchy is the need for appreciation, respect, to
have self-esteem, and self-respect. When the needs at the bottom three levels
have been satisfied, the esteem needs begin to play a more prominent role in
motivating behavior.

Also known as the belonging need, esteem presents the normal human desire to
be accepted and valued by others. People have a need to accomplish things and
then have their efforts recognized. In addition to the need for feelings of
accomplishment and prestige, esteem needs include such things as self-esteem
and personal worth.

People need to engage themselves:

○ To gain recognition
○ Have an activity or activities that give the person a sense of contribution
○ To feel accepted and self-valued, be it in a profession or a hobby.

Imbalances at this level can result in low self-esteem or an inferiority complex.

Those who lack self-esteem and the respect of others can develop feelings of
inferiority.

Two versions of esteem:

○ Low self-esteem
▪ Need for the respect of others, the need for status, recognition, fame, prestige and
attention.
○ High self-esteem
▪ The need for self-esteem, strength, competence, mastery, self-confidence,
independence, and freedom.

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After the first three needs have been satisfied, esteem needs become increasingly
important. Together, the esteem and social levels make up what is known as the
psychological needs of the hierarchy.

5. Self-actualizing Needs
• At the very peak of Maslow’s hierarchy are the self-actualization needs. "What a
man can be, he must be," Maslow explained, referring to the need people have to
achieve their full potential as human beings. This is the highest level of Maslow’s
hierarchy of needs.

Self-actualizing needs is the motivation to realize one’s own maximum potential and
possibilities. The need for self-actualization is the final need that manifests when lower
level needs have been satisfied.

Self-actualizing people are self-aware, concerned with personal growth, less concerned
with the opinions of others, and interested in fulfilling their potential.

Maslow wanted to understand what motivates people. He believed that people possess
a set of motivation systems unrelated to rewards or unconscious desires.

The deficiency, or basic needs are said to motivate people when they are unmet. Also,
the need to fulfill such needs will become stronger the longer the duration they are
denied. For example, the longer a person goes without food the hungrier they will
become.

One must satisfy lower level basic needs before progressing on to meet higher level
growth needs. Once these needs have been reasonably satisfied, one may be able to
reach the highest level of self-actualization.

Every person is capable and has the desire to move up the hierarchy toward a level of
self-actualization. Unfortunately, progress is often disrupted by failure to meet lower
level needs. Life experiences including divorce and loss of job may cause an individual
to fluctuate between levels of hierarchy.

The original hierarchy of needs five-stage model includes:

1. Biological and physiological needs – air, food, drink, shelter, warmth, sex, sleep
2. Safety needs – protection from elements, security, order, law, stability, freedom
from fear
3. Love and belongingness needs – friendship, intimacy, affection and love (from
work group, family, friends, and romantic relationships)
4. Esteem needs – achievement, mastery, independence, status, dominance,
prestige, self-respect, respect from others
5. Self-actualization needs – realizing personal potential, self-fulfillment, seeking
personal growth and peak experiences.

The Expanded Hierarchy of Needs

It is important to note that Maslow’s five stage model has been expanded to include

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cognitive and aesthetic needs, and later transcendence needs. Changes to the original
five-stage model are highlighted and include a seven-stage model and an eight-stage
model, both developed during the 1960’s and 1970’s.

The three new additions to Maslow’s original Hierarchy of Needs model are:
• Knowledge and Understanding (Cognitive needs)
• Need for Aesthetics
• Transcendence

At first, Maslow’s main concern was with the top tier, self-actualization—he didn’t think
that was the pinnacle of the framework. As he furthered the research, he saw that self-
transcendence, was a higher, and separate, need.

Today, the theoretical framework includes eight parts that are divided into deficiency
needs and growth needs:

Deficiency Needs:
1. Physiological needs
2. Safety needs
3. Social/belonging needs
4. Esteem needs

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Growth Needs:
1. Cognitive needs
2. Aesthetic needs
3. Self-actualization
4. Self-transcendence

Knowledge and Understanding (Cognitive Needs)

• This the need to learn and would clearly be a growth need. People have a desire to
explore and learn new things or understand the world around them. The inability to
meet the cognitive needs may make it difficult to reach Self-Actualization. Self-
Actualization is about personally growing and is a more complex form of gaining
knowledge and understanding.

Need for Aesthetics

• This is about the desire for beauty and pleasing surroundings in our life. Through
the chaos, we seek order and balance. We want to appreciate the things we find
beautiful; you may stop to smell the roses.

Transcendence
• Transcendence is the desire to move beyond ourselves. In the expanded hierarchy
it is placed after Self-Actualization, making it the highest level in the hierarchy.
People seeking to fulfill their Transcendent needs may be motivated by helping
others or becoming wholly driven by factors that do not personally impact them.
They are so confident in their lower level needs being met satisfactorily that they
worry about the needs of others.

SELF-ACTUALIZATION
Instead of focusing on psychopathology and what goes wrong with people, Maslow
formulated a more positive account of human behavior which focused on what goes
right. He was interested in human potential, and how we fulfill that potential.

Maslow stated that human motivation is based on people seeking fulfillment and change
through personal growth. Self-actualized people are those who were fulfilled and doing
all they were capable of.

The growth of self-actualization refers to the need for personal growth and discovery
that is present throughout a person’s life. For Maslow, a person is always “becoming”
and never remains static in these terms. In self-actualization a person comes to find a
meaning to life that is important to them.

As each person is unique, the motivation for self-actualization leads people in different
directions. For some people self-actualization can be achieved through creating works

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of art or literature. For others, through sport, in the classroom, or within the corporate
setting.

Maslow believed that self-actualization could be measured through the concept of peak
experiences. This occurs when a person experiences the world totally for what it is, and
there are feelings of euphoria, joy and wonder.

It is important to note that self-actualization is a continual process of becoming rather

than a perfect state one reaches of a “happy ever after”.

Maslow offers the following description of self-actualization:

• It refers to the person’s desire for self-fulfillment, namely, to the tendency for him to
become actualized in what he is potentially. The specific form that these needs will
take will vary greatly from one person to another. In one individual it may take the
form of the desire to be an ideal mother. In another, it may be expressed
athletically, and in still another it may be expressed in painting pictures or in
inventions.

Some of the characteristic of self-actualized people

Although we are all, theoretically, capable of self-actualizing, most of us will not do so,
or only to a limited degree. Maslow estimated that only two percent of people will reach
the state of self-actualization. He was particularly interested in the characteristics of
people whom he considered to have achieved their potential as persons.

By studying 18 people he considered to be self-actualized (including Abraham Lincoln

and Albert Einstein), Maslow identified 15 characteristics of a self-actualized person
Characteristics of self-actualizers:
1. They perceive reality efficiently and can tolerate uncertainty
2. Accept themselves and others for what they are

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3. Spontaneous in thought and action

4. Problem centered (not self-centered)
5. Unusual sense of humor
6. Able to look at life objectively
7. Highly creative
8. Resistant to enculturation, but not purposely unconventional
9. Concerned for the welfare of humanity
10. Capable of deep appreciation of basic life-experience
11. Establish deep satisfying interpersonal relationships with a few people
12. Peak experiences
13. Need for privacy
14. Democratic attitudes
15. Strong moral/ethical standards

Behaviors leading to self-actualization:

• Experiencing life like a child, with full absorption and concentration
• Trying new things instead of sticking to safe paths
• Listening to your own feelings in evaluating experiences instead of the voice of
tradition, authority, or the majority
• Avoiding pretense (game playing) and being honest
• Being prepared to be unpopular if your views do not coincide with those of the
majority
• Taking responsibility and working hard
• Trying to identify your defenses and having the courage to give them up.

The characteristics of self-actualizers and the behaviors leading to self-actualization are

shown in the list above. Although people achieve self-actualization in their own unique
way, they tend to share certain characteristics. However, self-actualization is a matter of
degree, as according to Maslow “There are no perfect human beings.”

It is not necessary to display all 15 characteristics to become self-actualized, and not

only self-actualized people will display them. Maslow did not equate self-actualization
with perfection. Self-actualization merely involves achieving one’s potential. Thus,
someone can be silly, wasteful, vain, and impolite and still self-actualize.

Application of Maslow’s Hierarchy of needs in the practice of pharmacy

The need to enhance the human connection within health care has implications for how
we practice pharmacy and may suggest areas for changes in pharmacy education.
Researchers have previously implied that the current model of health care delivery does
not adequately address the quality of patient experiences. A model of health care
delivery that emphasizes human connection is needed.

While the existing traditional biomedical model of health care delivery focuses mainly on
addressing physiological needs, an enhanced holistic model based on Maslow’s
hierarchy is needed to improve care delivery in today’s health care environment.

The first step for designing an enhanced health care delivery model requires an
understanding of the hierarchy of patients’ health care needs. Maslow’s theory of the

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hierarchy of needs, originally designed as a motivational theory, can serve as the basis
for the revised health care delivery model. Maslow proposed five hierarchies of needs
represented in a pyramid: physiological needs, safety needs, love and belonging needs,
self-esteem needs, and self-actualization.

Pharmacists could play a pivotal role in these centers for engagement. They could
serve as a new mid-level provider with a defined scope of practice when credentialed as
a qualified provider or serve as specialist consultants for complicated
pharmacotherapeutic challenges.

Additionally, pharmacists can concentrate their efforts on teaching patient’s self-

management skills, tailor their regimens to enhance adherence and use their
motivational interviewing skills to educate patients in an empathetic manner about the
significance of medication adherence.

Even if pharmacists do not become primary care providers, active involvement of the
“patient care literate” pharmacist (a pharmacist trained with enhanced interpersonal
skills) in a revised integrative PCMH model would improve care quality and help
address Maslow’s hierarchy of needs.

The use of health information technology could aid pharmacists in their efforts as they
develop skills and abilities of patients. Thus, pharmacists working with centers of
engagement could meet the various hierarchies of patients’ needs, eventually
developing them to become self-actualized and health literate.

Physiological needs are currently met by advances in medication distribution systems

and use of technology.

Safety needs will be enhanced when a patient uses integrated electronic medical
records to promote communication and sharing of information.

Pharmacists’ enhanced self-awareness, empathy, and patient care literacy centered

attitudes could help address patients’ call for a health care provider who will listen and
be concerned with them as a person. Pharmacists can help meet self-esteem needs by
enhanced involvement in providing individualized education and developing patients’
confidence in self-monitoring and adherence, so patients become informed and active
health care participants.

Training in techniques such as motivational interviewing will help develop pharmacist

roles in this area. The need for self-actualization where patients becomes more
independent about advocating and seeking their own care needs is the ultimate goal.

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Advances in technology for drug distribution coupled with educational reforms would
allow pharmacists to assume an increased role in meeting the different hierarchies of
patients’ needs. Educational reforms, which emphasize interprofessional collaboration,
enhanced communication skills, human connection in patient experiences, which
develops both patient-centered attitudes and the use of health information technology
should be accelerated in existing curricula. These changes would assist in expanding
pharmacists’ roles in this revised health care delivery model.

Maslow’s theory and Patient care

Each person is unique, and driven by different and dynamic motivating factors, which
operate singly or in conjunction with each other, in varying degrees. Motivation is
influenced by multiple internal and external factors. Education and health literacy, an
understanding of one’s body, and functional limitations due to symptoms of disease are
examples of internal variables which modulate motivation. External variables include
exposure to disease in the family and community, comfort with the health care system
and health care team, and availability of resources. All these factors merge together to
create a hierarchy of attitudes towards health.

• Level 1 – physiological needs

At base level, a person has simple needs. They expect symptomatic relief from their
physician and may not be concerned about ‘healthy numbers’ or long-term outcomes.
Engagement with the healthcare system aims to ensure functional adequacy, and enjoy
reasonably good quality of life. It is important for the healthcare team to ensure that the
leading complaints of the individual are addressed before proceeding further.

“I understand you are bothered by body aches and fatigue. Let us begin this treatment
as it will help increase your energy and wellbeing, and allow you to do gardening that

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you enjoy so much”.

• Level 2 – safety needs

Once primary concerns have been addressed, focus of care shifts to safety. This is
reflected in our version of Maslow’s model. Significant emphasis has been placed on
choosing pharmacological treatments to attain therapeutic goals while avoiding side-
effects. People who voice concerns about safety of treatment, must be reassured of the
tolerability of prescribed medication, to ensure adherence.

“It is natural to have concerns about the side effects of medicines and I am glad you
brought that up. This drug has a low risk of hypoglycemia and doesn’t damage kidneys.
In fact, it helps the kidneys and the heart.”

• Level 3 – love and belonging

The need for love and belonging is evident in patients with disease as well. People with
diabetes require a warm and close relationship with their health team, family and society
at large.

“While we are using the best possible medication, is there any emotional issues I can
help you with? Are there any issues that particularly upset you?”

• Level 4 – esteem
While many people are happy accepting physician-driven therapy, others appreciate
active involvement in their care. This is a means of maintaining their self-esteem.
Such people need self-management, education and skill enhancement, and welcome
shared decision-making. Discussion should specifically include challenges to self-
esteem faced by the patient, including social challenges such as self-injection at work or
in public.

“I understand you are worried that insulin injections will interfere with your freedom to
move about and may create social embarrassment. This pen can fit in your pocket; you
can inject as convenient, and do not have to disclose diabetes.”

• Level 5 – self-actualization
Self-actualization is the pinnacle of needs. The self-actualized person is one who
achieves his or her full potential. This is the ‘dream patient’, who has mastered self-
care, can treat and monitor oneself, and works with the medical team to ensure optimal
outcomes. They are more likely to become true partners in the shared decision-making
process.

“How well you are controlled today will impact your health over the long term, like
karma. The treatment we suggest will improve your metabolic karma and reduce the
risk of cardiovascular disease.”

• Level 6 – self-transcendence

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Maslow later added another motivational level, termed self-transcendence.14 This can
be applied to self-actualized patients with diabetes, who wish to make a difference in
their treatment care, beyond their individual management. These people wish to
improve health of others.

Questions:
1. Abraham Maslow's hierarchy of needs theory is about:
a. positive mental health
b. what motivates people to do the things they do
c. the human mind
d. how successful someone can be

2. According to Abraham Maslow, what is the most important need that must be
fulfilled first?
a. esteem needs
b. love and belongingness needs
c. physiological needs
d. safety needs

3. What is the order of needs, from bottom to top?

a. safety, physiological, love, esteem, self-actualization
b. physiological, safety, love, esteem, self-actualization
c. self-actualization, esteem, love, safety, physiological
d. There is no order

4. Which Stage of Maslow's Hierarchy of Human Needs does this phrase belong to: I
like to lock my door at night.
a. Self-Actualization
b. Esteem
c. Safety/Security
d. Physiological

5. When parents say "you will never be good enough to go to college ” they are not
helping their child achieve
a. safety and security
b. love and belonging
c. self-actualization
d. esteem

6. Do you believe that Maslow’s Hierarchy of Needs is true for every culture?

Module Assessment and Evaluation

a. Rubrics

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Method
Please see online quiz link as provided by the faculty.

References:
• The Hierarchy of Needs – Maslow’s Theory Applied to the Science of Diabetes.
Sanjay Kalra, Gagan Priya, Deepak Khandelwal. January 24th 2019
• Applying Maslow’s hierarchy of needs to human-centered design translating
HCAHPS results into designs that support improved care delivery. J. Todd
Robinso
• Pharmacy in an Improved Health Care Delivery Model Using Maslow’s Hierarchy of
Needs. Therese I. Poirier, PharmD, MPH, and Radhika Devraj, PhD. October
2019
• Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50,
370–396.
• Maslow, A. H. (1954). Motivation and personality. New York: Harper
• Maslow, A. H. (1969). The farther reaches of human nature. Journal of
Transpersonal Psychology, 1(1), 1–9.
• Maslow, A. H. (1979). The journals of A. H. Maslow (R. J. Lowry, Ed.; Vols. 1–2).
Monterey, CA: Brooks/Cole.
• Maslow, A. H. (1982). The journals of Abraham Maslow (1-vol. ed.; R. J. Lowry,
Ed., & J. Freedman, Abridger). Brattleboro, VT: Lewis.
• https://www.psychologytoday.com/us/blog/hide-and-seek/201205/our-hierarchy-
needs/
• https://www.britannica.com/biography/Abraham-H-Maslow
• https://www.verywellmind.com/what-is-maslows-hierarchy-of-needs-4136760
• https://www.masterclass.com/articles/a-guide-to-the-5-levels-of-maslows-
hierarchy-of-needs#want-to-learn-more-about-business
• https://agile-mercurial.com/2019/06/20/abraham-maslows-expanded-hierarchy-of-
needs/
• https://www.interiorsandsources.com/article-details/articleid/22727/title/maslow-
hierarchy-design-architecture-impacts

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