This bar graph demonstrates a decrease in the percentage of mortality in the ICU and the total percentage of mortality in the hospital after using the ABCDE bundle compared with procedures prior to using the bundle. This is a significant discovery, as we now know we can improve time alive and off of ventilators using this bundle.
Maslow’s Hierarchy of Needs in Critical Care
In 1943, psychologist Abraham Maslow proposed his theory of a hierarchy of human needs. Presented as a pyramid, one must satisfy the lower level, basic needs before progressing to meet higher level needs.
In 2014, Jackson et al. adapted the concept of Maslow’s hierarchy of needs to illustrate the needs of patients in the critical care setting. The base of the pyramid is physiological, dealing with support for failing organs such as using mechanical ventilation, vasopressors, and dialysis, pain and symptom management, and nutrition.
The next level deals with safety through protocolization, the ABCDEF bundle, and delirium monitoring and management for the prevention of such errors as hospital-acquired infections, falls, deep vein thromboses, pressure ulcers, and medication errors.
Love and belonging form the next tier, which includes the open visitation of family and friends, family rounds, daily awakening of the patient for family interaction, post-ICU support groups, and post-ICU clinics. It’s more dignified to allow patients to communicate on their own with their family and health care providers.
Esteem, above love and belonging, involves respectful team communication, recognition of the dignity and value of each patient, and optimizing pre-illness cognition and physical function through rehabilitation.
The highest point of Maslow’s hierarchical pyramid is self-actualization, which incorporates spiritual values into patient care, breeds acceptance of new limitations, and allows the patient to reconcile with a new identity. Light sedation for patients that are awake is as much a physical, spiritual, and mental element as it is about health. It’s important to be considerate of the patient’s mind and spirit so that the patient can be cared for in his or her entirety.