Seeking Safety and Security

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• Priscilla Ebersole, RN, PhD, FAAN

The Maslovian concept of human need has been a convenient way to address the issues of aging. The pyramidal structure of these needs are ranked in a hierarchy with basic needs such as food, fluids, shelter, and all the aspects of biologic integrity on the bottom rung. For many elders, these are not well met and become the major focus of concern. When these are achieved, the next rung of significance is achieving safety and security. Above these are a sense of belonging, then self-esteem, and at the peak of the pyramid is self-actualization. The design is straightforward and the areas discretely separated for the purpose of simplicity, but it is clear in Maslow’s writings and in practice that all needs are intermingled; in meeting one need, others are often partially resolved as well. This humanistic framework guides one to think beyond the limitations in bodily function that often become the focus of professionals caring for the aged. In this issue of Geriatric Nursing we are somewhat focused on issues of safety and security.

There is a thrust in much of the geriatric literature that focuses on various aspects of safety, medications being one of the most frequently discussed. Fall prevention is another issue of significance. Increasingly, there is concern about the safety of hospital personnel who encounter dangerous and increasingly unsafe situations.

The nurse shortage benefits institutions and is an excuse for the inadequate number of RNs and other personnel in hospitals and long-term care situations. These account for a great number of problems in the safety of patients and health care providers. We have said before and will say again that concerned professionals must refuse to work where there is inadequate personnel. There are many institutions that hold high standards and appropriate patient-to-personnel ratios, so we know it can be done.

Achieving a sense of safety in our world today is extremely difficult—perhaps it always has been. In part, this has to do with mind-set. Those with an optimistic bent may simply see things through a pink-tinted lens, while pessimists look through a darkened glass. Yet to a large degree, it depends on where we look. Those with the dark glass can stare in the face of an eclipse of the sun, which happens only rarely, and perhaps be awe struck, whereas those with the gloriously tinted glass will see beauty in ordinary everyday events. As caregivers, we try to walk a fine line between optimism and pessimism as we seek truth and advocacy, although these are often clouded by our limited concepts of reality.

Fear is another mental state that skews perceptions—fear of the immediate future and fears of events and experiences that may occur. These can be addressed directly by simply asking what an individual is afraid may happen and by listening thoughtfully without platitudes or false assurances. Fears expressed may lose some of their potency.

Within these parameters, we approach the aged in our care. Do we make mistakes and often falter in our mission? Of course. It is the manner in which we handle these mistakes that makes the difference between compassion and growth or guilt and failure.

The elders we care for who seem to feel most secure are those involved with others and with ideas beyond their immediate situation, those who retain a sense of humor, those who have a transcendent concept of life, and those whose pain is appropriately addressed. Nonetheless, even those remarkable people who have achieved some satisfaction at all the levels of the human-needs hierarchy are at times overwhelmed with fears and concerns about their basic biologic function. They can be assured that this is a necessary concern when the body betrays the individual’s expectations. This betrayal erodes confidence and feelings of security. There is no betrayal quite so devastating as that experienced when one’s body falters. It entails a fundamental loss of trust. Thus, caregivers become the source of trust by exhibiting sincere concern, reliability, and dependability. We meet the patient, client, or resident wherever they are at the moment of each encounter and at whichever level on the human-need hierarchy they have attained. Each is struggling to make meaning of the situation. Nurse and client benefit as they seek mutual understanding.