Nurses are educated to assist persons in meeting basic need requirements. Nurses may be able to help clients elevate themselves in the basic need hier- archy moving toward self-actualization and increasing the likelihood that they will perform health-promoting self-care behavior?

Nurses are educated to assist persons in meeting basic need requirements. Nurses may be able to help clients elevate themselves in the basic need hier- archy moving toward self-actualization and increasing the likelihood that they will perform health-promoting self-care behavior?

Journal of Nursing Research

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Health-promoting self-care behavior emphasizing positive lifestyle practices may improve the health and quality of life of adults. One variable that may influence health-related decisions is the status of basic needs as described by Maslow. The purpose of this study was to investigate the relationships among basic need satisfaction, health-promoting self-care behavior, and selected demographic variables in a sample of community-dwelling adults. A convenience sample of 84 community-dwelling adults was recruited to complete the Basic Need Satisfaction Inventory, the Health-Promoting Lifestyle Profile II, and demographic information. Results of the study indi- cated that self-actualization, physical, and love/belonging need satisfaction accounted for 64% of the variance in health-promoting self-care behavior. The findings of this study are consistent with Maslow’s theory of human motivation and suggest that persons who are more fulfilled and content with themselves and their lives, have physical need satisfaction, and have positive con- nections with others may be able to make better decisions regarding positive health-promoting self-care behaviors.

Health-promoting self-care is a way for people to take control of their health (Haug, Wykle, & Namazi, 1989) and is a strategy for attaining national health goals (Pender, 1996). To date, however, much of the research into self-care behavior has been conducted within an illness or problem-oriented paradigm and has been designed to predict medical outcomes, such as the use of health care services, physician visits, and medical care expenses. A variety of factors, including a new emphasis on managing chronic conditions rather than curing disease, aging of the population, and increases in expenditures of health care dollars, have shifted the focus of health care delivery away from acute care toward health promotion and disease prevention (McLeroy & Crump, 1994). Research has demonstrated that lifestyle choices may decrease

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Western Journal of Nursing Research, 2000, 22(7), 796-811

Gayle J. Acton, Ph.D., R.N., Assistant Professor, The University of Texas at Austin School of Nursing;Porntip Malathum, M.Ed. (Nursing), Doctoral Student, The University of Texas at Austin School of Nursing.

© 2000 Sage Publications, Inc.
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the incidence and severity of chronic conditions (Dean, 1989; Paffenbarger & Hyde, 1980; Paffenbarger, Hyde, Wing, & Hsieh, 1986; Paffenbarger, Wing, Hyde, & Jung, 1983; Rowe & Kahn, 1998). Thus, health promotion empha- sizing positive lifestyle practices may improve health and quality of life and decrease health care costs.

Embedded in the concept of health promotion is self-responsibility, or accountability for actions (or nonactions) regarding health. That is, persons are responsible for their health and health is largely self-determined through self-care actions. For individuals to engage in health-promoting behavior, they must be motivated to take personal responsibility for their health.

Little research, however, has focused on health-promoting self-care actions to produce health-oriented outcomes and variables related to posi- tive self-care decisions. One variable that may influence health-related deci- sions is the status of basic needs as described by Maslow (1970). According to Maslow’s theory of human motivation, the actions one takes are largely motivated by the needs of the individual. Basic needs are arranged in a hier- archy as physical, safety/security, love/belonging, esteem/self-esteem, and self-actualization needs. The hierarchy implies that lower needs must be met before higher needs emerge. For example, if the human being is deprived of oxygen, then concerns about safety and belonging may not matter. Needs actually exist in a quasi-hierarchy, and when the most urgent needs are par- tially or fully satisfied the next level emerges, ending with the search for self-actualization. Unmet needs result in a state of tension or anxiety; as the deficit increases, so does the tension, which ultimately leads to a state of per- ceived deprivation. There is always an inherent drive to relieve the tension caused by unmet needs and achieve need satisfaction. When relief occurs, the tension is decreased and the person can focus on other aspects of his or her life, such as health promotion. Maslow’s theory of human motivation suggests that persons experiencing higher levels of need satisfaction will have lower levels of tension and will not be in a state of deprivation; thus, they might be motivated to make better decisions regarding self-care and health promotion. Therefore, the purpose of this study was to (a) investigate the relationships among basic need status, health-promoting self-care be- havior, and selected demographic variables and (b) determine the best pre- dictors (physical needs, safety/security needs, love/belonging needs, esteem/ self-esteem needs, or self-actualization needs) of health-promoting self-care behavior in a sample of community-dwelling adults.

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Basic Needs and Health-Promoting Self-Care Behavior

Leidy (1994) found that a sample of healthy adults scored higher in basic need satisfaction than a group of chronically ill adults; however, little research has explored these variables. In one of the few studies of the vari- ables, Laffrey (1985) examined the relationship between “promotiveness of health behavior choice and self-actualization” (p. 290) in 95 adults ages 18 to 69 who were randomly selected from households in three midwestern suburban cities. Laffrey used the Personal Orientation Inventory (POI) (Shostrom, 1974) to measure values and behaviors important to the develop- ment of the self-actualized person and the Health Behavior Choice Scale (HBCS) to measure participants’ reasons for engaging in sleep/rest, relaxation, physical exercise, nutrition, and dental care. Laffrey’s findings, however, failed to support her hypothesis that there would be a significant relationship between self-actualization and promotiveness of health behavior choice.

In a study similar to Laffrey’s (1985), Petosa (1984) examined the rela- tion between self-actualization and health practices in 421 college students. Like Laffrey, Petosa used the POI to measure indicators of self-actualization; however, unlike Laffrey, Petosa used the Health Practices Inventory (Baum, 1972) to measure actual health practices related to personal and dental health, rest and sleep, relaxation, chronic disease, family living, environ- mental health, safety and accident prevention, nutrition, physical activity, recreation, communicable disease, mental health, consumer health, and drug use. Petosa found a significant relationship between self-actualization and health promotion practices.

Whereas Laffrey’s (1985) and Petosa’s (1984) results may appear to con- flict, the difference may be explained by differences in the study measures. Laffrey’s study evaluated the reasons for engaging in a limited scope of health-promoting behaviors (sleep, relaxation, exercise, nutrition, and den- tal care), whereas Petosa measured the actual practice of a wide variety of health-promotion behaviors. Thus, the studies were evaluating two different conceptions of health promotion behavior. In addition, neither Petosa nor Laffrey examined the relationships among physiological needs, safety/ security needs, love/belonging needs, esteem/self-esteem needs, and health behaviors. The present study examined the links between all of Maslow’s (1970) basic needs, including self-actualization and health-promoting self- care behavior.

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Demographic Variables and Health-Promoting Self-Care Behavior

Support for the relationships among the demographic variables and health- promoting self-care can be found in several studies. Researchers found that increased self-care activities were related to higher social class (Dean, 1989; Hanucharurnkul, 1989; Weerdt, Visser, Kok, & van der Veen, 1990) and higher income (Ahijevych & Bernhard, 1994; Ailinger, 1989). Several researchers (Ahijevych & Bernhard, 1994; Ailinger, 1989; Gottlieb & Green, 1984; Muhlenkamp & Sayles, 1986; Segall & Goldstein, 1989; Weerdt et al., 1990) found that more education and increasing age (Ailinger, 1989; Bausell, 1986; Gottlieb & Green, 1984; Muhlenkamp & Sayles, 1986; Prochaska, Leventhal, Leventhal, & Keller, 1985; Walker, Volkan, Sechrist, & Pender, 1988) were also related to increased self-care activities. Regarding employment and self-care, Frank-Stromborg, Pender, Walker, and Sechrist (1990) found employment to be a significant predictor of a health-promoting lifestyle in persons with cancer, and Duffy, Rossow, and Hernandez (1996) found employment to be a significant predictor of a health-promoting lifestyle in Mexican-American women. Taken collectively, the research indicates that employed persons of higher social class and income who had more educa- tion tended to engage in more health-promoting self-care behavior. In addi- tion, as persons age, their health-promoting self-care behavior tends to increase.

METHOD

Procedure

Permission to conduct the study was granted by the appropriate human par- ticipants review committee. The sample for the study consisted of community- dwelling adults recruited from a conference for lay persons and profession- als interested in issues concerning older adults. Attendees received the survey questionnaires in their packet of registration materials. A cover letter explained the study and stated that return of the questionnaires to the researcher indi- cated consent to participate in the study. The participants completed the

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questionnaires during breaks and/or at lunchtime during the conference and returned them to the researcher at a centrally located display table.

Sample

Eighty-four adults completed the questionnaires. The ages of the partici- pants ranged from 21 to 79 years, with the average age being 48.49 years. Of the sample, 87% were female. Most were White (84.5%), 7.1% were Black, 3.6% were Hispanic, and 3.6% of the sample reported another unspecified ethnicity. Sixty-eight percent had a college education. Of the sample, 69% were employed and 53.6% reported their family annual income as $36,000 or more (see Table 1).

Instruments

Basic needs. Basic needs status was measured by the Basic Needs Satis- faction Inventory (BNSI) developed by Leidy (1994). The BNSI contains subscales analogous to Maslow’s (1970) theoretical description of the basic needs categories: physical, safety/security, love/belonging, esteem/self-esteem, and self-actualization. Five subscale scores and a total scale score can be computed reflecting an individual’s need satisfaction status in each category and overall need status. The BNSI contains 27 items. The stem for each item asks how one feels about various aspects of life. Participants respond on a Likert-type scale ranging from 1 (terrible) to 7 (delighted). The ratings are summed for a possible range of scores from 27 to 189. Extensive validity and reliability testing of the BNSI has been described elsewhere by Leidy (1994). Cronbach’s alphas have been reported to range from .90 to .94 (Irvin & Acton, 1996; Leidy, 1990, 1994). Reliability coefficients in this study were .90 for the total scale and .82, .85, .85, .82, and .88 for the physical, safety/ security, love/belonging, esteem/self-esteem, and self-actualization subscales, respectively.

Health-promoting self-care behavior. The Health-Promoting Lifestyle Profile II (HPLP II) (Walker, Sechrist, & Pender, 1995) was used to measure health-promoting self-care behavior. The HPLP II is a revision of the original Health-Promoting Lifestyle Profile (Walker, Sechrist, & Pender, 1987) used extensively in health promotion research. The HPLP II was revised to better reflect current practice related to health promotion activities. The HPLP II measures health-promoting self-care behavior conceptualized as a multi-

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dimensional pattern of self-initiated actions that maintain or enhance the level of wellness and health potential of the individual. The 52-item instru- ment employs a 4-point response scale to measure the frequency of self-reported health-promoting behaviors in the areas of health responsibil- ity, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management. Thus, the HPLP II represents a holistic evaluation of

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TABLE 1: Demographic Characteristics

Characteristic n Percentage

Age Less than 50 44 53.6 Greater than or equal to 50 38 46.3

Gender Male 10 11.9 Female 73 86.9

Ethnicity White 71 84.5 Black 6 7.1 Hispanic 3 3.6 Unspecified 3 3.6

Marital status Married 53 63.1 Divorced 18 21.4 Widowed 4 4.8 Single 7 8.3

Educational level Less than high school 1 1.2 High school graduate 10 11.9 Some post–high school or

graduate of technical school 15 17.8 College graduate 57 67.9

Employment status Employed 58 69.0 Unemployed 6 7.1 Retired 11 13.1 Homemaker 2 2.4 Other 6 7.1

Family income (in dollars) 15,000 or less 7 8.4 16,000 to 25,000 20 23.8 26,000 to 49,000 25 29.8 50,000 to 75,000 19 22.6 76,000 or more 11 13.1

NOTE: The percentage columns may not total 100% due to missing data.

health-promoting self-care behaviors. Cronbach’s alphas are reported by Walker and colleagues (1995) as follows: health responsibility (.86), physi- cal activity (.85), nutrition (.80), spiritual growth (.86), interpersonal rela- tions (.87), stress management (.79), and total scale (.94). Cronbach’s alphas in this study were .90 for the total scale and .88, .86, .83, .90, .85, and .85 for the health responsibility, physical activity, nutrition, spiritual growth, inter- personal relations, and stress management subscales, respectively.

Demographic data. Participants completed a form containing questions concerning age, gender, ethnicity, marital status, education, income, and employment status. Research has shown these variables to be linked to health promotion activities.

RESULTS

With a possible range of 27 to 189 on the BNSI, the group mean score of 137.71 (SD = 23.80) indicates that the participants in this study were experi- encing moderately high levels of basic need satisfaction. The group mean of 138.90 (SD = 27.08, range = 52 to 208) on the HPLP II shows that the partic- ipants were engaging in moderate numbers of health-promoting self-care behaviors (see Table 2).

The correlations between the BNSI subscales and the HPLP II are dis- played in Table 3. Those persons who reported greater physical (r = .66), safety/security (r = .64), love/belonging (r = .68), esteem/self-esteem (r = .62), and self-actualization (r = .76) need status reported more health- promoting self-care behaviors. In addition, correlations among the subscales of the BNSI ranged from .48 to .76 (p < .001).

Stepwise regression analyses were used to examine the ability of the basic need subscales to predict health-promoting self-care behavior. Tests for violations of the multiple regression assumptions were negative (Munro, 1997). Multicolinearity tests revealed that no correlation coefficient exceeded .80 and variance inflation factors for the regression analyses ranged from 1.000 to 2.506, far below the caution point of 10 (Stevens, 1996).

Data reporting the ability of the basic need subscales to predict health- promoting self-care behavior are displayed in Table 4. Self-actualization was the first variable to enter the equation, and it accounted for 58% of the variation in health-promoting self-care behavior. Physical need satisfaction increased the variance by 5% and love/belonging satisfaction increased

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TABLE 2: Descriptive Data for the Basic Need Satisfaction Inventory (BNSI) Subscales and the Health-Promoting Lifestyle Profile II (HPLP II)

Scale M SD Range

BNSI total 137.71 23.80 27 to 189 Self-actualization 31.15 6.04 6 to 42 Esteem/self-esteem 20.79 3.82 4 to 28 Love/belonging 26.99 5.28 5 to 35 Safety/security 29.90 6.14 6 to 42 Physical 28.88 6.39 6 to 42

HPLP II total 138.90 27.08 52 to 208

TABLE 3: Correlations Among the Health-Promoting Lifestyle Profile II (HPLP II) and the Basic Need Satisfaction Inventory (BNSI) Subscales

Safety/ Love/ Esteem/ Self- HPLP Physical Security Belonging Self-Esteem Actualization II

Physical 1 Safety/

security .73 1 Love/

belonging .65 .72 1 Esteem/

self-esteem .54 .48 .75 1 Self-

actualization .66 .76 .71 .66 1 HPLP II .66 .64 .68 .62 .76 1

NOTE: All variables are correlated at p < .001, two-tailed.

TABLE 4: Stepwise Regression Predicting Health-Promoting Self-Care Behav- ior From the Basic Need Satisfaction Inventory (BNSI) Subscales

Variable R2 Overall F Sig F R2 Change F Change Sig Change

Self-actualization .58 113.26 .000 .58 113.26 .000 Physical .63 67.66 .000 .05 9.84 .002 Love/belonging .64 48.13 .000 .02 4.03 .048

the variance by 1%. Together, these three variables accounted for 64% of the variance in predicting health-promoting self-care behavior. Thus, self- actualization, physical, and love/belonging need satisfaction predicted engagement in health-promoting self-care behavior.

Because there was some concern about overlap between the self- actualization subscale of the BNSI and the spiritual growth subscale of the HPLP II, the spiritual growth subscale was removed from the HPLP II and the stepwise regression analysis was repeated. The results indicated that self-actualization was still the first variable to enter (R2 = .52, p < .01) the regression equation; thus, concerns about the overlap were allayed.

The relationships among the categorical demographic variables (ethnic- ity, marital status, education, employment, and income), health-promoting lifestyle, and basic need satisfaction were examined using t tests and ANOVA. Chi-square statistics were used to examine the relationships among the cate- gorical demographic variables. The categorical demographic variables were dichotomized as follows: White or other ethnicities, married or unmarried (divorced, separated, single, or single living with another), and high school education or college education. The income variable was divided into three groups—low income (less than $15,000), medium income ($15,001 to $50,000), and high income (greater than $50,000)—as was the employment variable (employed, retired, or unemployed). Relationships among age, health-promoting self-care behavior, and basic need satisfaction were exam- ined using Pearson product-moment correlation.

Participants with a higher family income were more likely to be married (χ2 = 23.00, p < .001), had a higher educational level (χ2 = 6.40, p < .05), had a higher basic need satisfaction (ANOVA: F(2, 79) = 3.39, p < .05), and engaged in more health-promoting behaviors (ANOVA: F(2, 79) = 4.99, p < .05). Participants who were currently married had a higher education level (χ2 = 6.40, p < .05) and higher basic need satisfaction (t test = –.50, df = 80, p < .05). Participants with higher education engaged in more health- promoting behaviors (t test = –3.26, df = 81, p < .05) and had higher basic need satisfaction (t test = –2.26, df = 81, p < .05). Participants who were cur- rently employed performed fewer health-promoting behaviors (ANOVA: F(2, 80) = 3.39, p < .05). Post hoc tests indicated that those participants who were retired engaged in more health-promoting behaviors than those who were employed. Participants who had higher basic need satisfaction were more likely to engage in health-promoting behaviors (r = .79). There were no significant associations between age, gender, ethnicity, and health- promoting self-care behavior or basic need satisfaction. In addition, there were no significant associations between marital status and health-

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promoting self-care behavior or between employment status and basic need satisfaction.

DISCUSSION

Basic Needs and Health-Promoting Self-Care Behavior

The significant relationship between basic need satisfaction and health- promoting self-care supports Maslow’s (1970) theory of human motivation. Maslow hypothesized that unmet needs and the desire to grow and move for- ward in life are the stimuli for human motivation. Maslow proposed that higher levels of need satisfaction may lead to the development of more resources and increased motivation for individuals to make better decisions (e.g., healthy lifestyle choices). In contrast, Maslow argued that unmet needs may contribute to increasing anxiety and tensions that theoretically might lead to unhealthy practices and perhaps even increased illness. The findings of this study support Maslow’s hypothesis that need satisfaction results in positive behavior motivation. Results show that persons with higher scores on basic need satisfaction engaged in more health-promoting self-care behavior and those with lower levels of need satisfaction reported fewer pos- itive health-related behaviors. In addition, Maslow theorized that basic need satisfaction is positively associated with psychological health. Better psy- chological health might free people to make better decisions about their health. Findings that college students who reported higher basic need satis- faction had lower levels of anxiety (Kalliopuska, 1992) support Maslow’s theory, and although the study reported here did not measure psychological health, future research could test the relationships among need satisfaction, anxiety, and health-promoting self-care behavior.

Self-actualization is at the top of the basic needs hierarchy and in this study it emerged as the best predictor of health-promoting self-care behav- ior. Self-actualization is defined as the “ongoing actualization of potentials, capacities and talents, as fulfillment of mission (or call, fate, destiny, or vocation), as a fuller knowledge of, and acceptance of, the person’s own intrinsic nature” (Maslow, 1968, p. 25). Maslow (1970) says that “what a man can be, he must be” (p. 46) and suggests that self-actualizing persons are motivated to be the best they can be in multiple aspects of their lives; thus, data from this study indicate that they may be better able to make healthy lifestyle choices. Maslow also argues that self-actualizing people tend to be able to accept themselves—therefore, they might have a better

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attitude toward themselves and their lives, so their ability to engage in health-promoting self-care may be increased. Laffrey (1985) states that health promotion behavior is indicative of a person’s striving to attain high- level health or increased general well-being. This is consistent with increased self-actualization need satisfaction when persons are continually striving to go forth in life, grow, develop, and be the best they can be. Findings that self- actualization was the best predictor of health-promoting self-care behavior is also consistent with Petosa’s (1984) finding that persons with higher lev- els of self-actualization were more likely to engage in healthier lifestyle behaviors. Persons who are more fulfilled and content with themselves and their lives may be better able to carry out health-promoting self-care behaviors.

Maslow (1970) says that the physiological needs are usually the starting point for human motivation and that at least partial satisfaction of physical needs is necessary for an individual to move toward satisfaction of higher needs. Physical need satisfaction predicted engagement in health-promoting self-care behavior in this study. That seems logical because when one does not have to worry about physical needs, it may be easier to focus on a healthy lifestyle. Physical need satisfaction may free the person from anxieties about things such as hunger or finding shelter that might occupy the mind and reduce health-promoting actions.

Maslow (1970) states that persons have a need to love and be loved and to feel like they belong to a group or an organization larger than the self. Per- sons deprived of love/belonging needs may feel alone and isolated, unable to seek assistance and support that might facilitate better health-related decision- making. In this study, love/belonging need satisfaction predicted engage- ment in health-promoting self-care behaviors. It may be that persons who feel more supported are better able to make good decisions and maintain a healthier lifestyle. Findings that social support (connections with others) (Cohen & Syme, 1985; Dean, 1989) and family support (Rakowski, Julius, Hickey, & Holter, 1987) may enhance health strengthen this conclusion.

Maslow (1970) states that as needs are met and persons do not feel in a state of deprivation, they are motivated to move toward more social goals. Health promotion may be considered a social goal. The publication of Healthy People 2000 is evidence of increased emphasis on healthy lifestyles in this country. Findings from this study show that as needs are met, espe- cially the higher needs, more attention may be paid to social goals such as health-promoting self-care behavior and perhaps healthier lifestyles.

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Demographic Variables

Persons who were currently married and had higher incomes and more education had greater basic need satisfaction, which is not surprising be- cause being married and having a higher income and more education may mean that one has more resources to satisfy basic needs. The results are con- sistent with Laffrey’s (1985) finding that education and income were posi- tively related to self-actualization. In addition, participants in the study who had higher levels of basic need satisfaction engaged in more health-promoting self-care behaviors. This is consistent with Leidy’s (1994) finding that scores on basic need satisfaction could discriminate between healthy and chronically ill individuals. Persons with higher levels of basic need satisfac- tion may have more resources and may be able to engage in more health- promoting self-care behaviors than other individuals. As needs are satisfied, persons may be able to more easily move forward in life and engage in behavior that is growth motivated (Maslow, 1968).

Age was not related to either basic need satisfaction or health-promoting be- haviors. This is comparable to Laffrey’s (1985) finding that self-actualization was not significantly correlated with the age of the participants. Leidy (1994) also found that age was not significantly correlated with basic need satisfac- tion. Differing from the findings of this study, Walker and colleagues (1988) found that older persons had higher scores on health-promoting self-care behavior than did young or middle-aged adults. These conflicting results may be explained by the fact that 77% of the participants in this study were employed and engaged in fewer health-promoting self-care behaviors, but those persons who were retired engaged in more positive health behaviors. Perhaps those persons who were older but still employed obscured a poten- tial positive relationship between increased age and health-promoting self- care behavior.

Gender and ethnicity were not associated with either basic need satisfac- tion or health-promoting self-care behavior. This may be due to the charac- teristics of the sample, which was overwhelmingly female, White, well edu- cated, and with adequate incomes, thus obscuring the variability that might have been found in a more diverse sample.

Education was also related to health-promoting self-care behavior, as in the work of others (Ahijevych & Bernhard, 1994; Ailinger, 1989; Gottlieb & Green, 1984; Muhlenkamp & Sayles, 1986; Segall & Goldstein, 1989; Weerdt et al., 1990). Uitenbroek, Kerekovska, and Festchieva (1996) found

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that persons who were better educated and employed engaged in healthier behaviors in regard to cigarette smoking, diet, alcohol consumption, and exercise than those who were less educated and employed. Conversely, par- ticipants in this study who were employed tended to engage in fewer health- promoting behaviors than those who were retired. One possible reason may be that employed persons have less time or are too tired to perform health-promoting activities.

Findings from this study demonstrate the importance that need satisfac- tion may have on the decisions people make about lifestyle, particularly health-promoting self-care behavior. Generalizations from these results must be made cautiously because random sampling was not employed and the design was descriptive. The sample was recruited from persons inter- ested in issues concerning older adults and thus may be more likely to be concerned about health issues because health is particularly important to older adults. Also, because this sample reported relatively high levels of need satisfaction, those persons who might score lower on Maslow’s (1968) hierarchy of needs are left underrepresented. More research (using random sampling) is needed to confirm and clarify the findings of this study. Sam- ples from lower socioeconomic levels and minority populations might also enhance the findings.

Despite the limitations of the study, the relationship between basic need satisfaction and health-promoting self-care behavior is intriguing and may be helpful in designing interventions to facilitate health-promoting self-care behavior. Nurses should assess basic need status and intervene to assist per- sons to meet their basic need requirements, especially with higher needs such as self-actualization. Persons have an inherent ability to grow and develop to their highest capacity. To do so, however, they need connections, support, and good information regarding the changes they are seeking to make. Nurses can facilitate these needs and help persons grow, develop, and realize their potential, especially in the area of positive, healthy lifestyles.

One other area of particular importance involves employed persons who, in this study, reported fewer health-promoting self-care behaviors. Health care professionals, particularly those working in occupational health, must help working adults build resources needed to engage in activities to promote health. Occupational health nurses may be able to suggest health-promotion strategies to employers. Activities such as health-related support groups, exercise time, health-related seminars, health fairs, and other health-related activities might assist working adults in increasing health-promoting self-care behavior.

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Nurses are educated to assist persons in meeting basic need requirements. Nurses may be able to help clients elevate themselves in the basic need hier- archy moving toward self-actualization and increasing the likelihood that they will perform health-promoting self-care behaviors. Maslow (1970) states that needs are satisfied through others by support, reassurance, acceptance, protection, willingness to listen, and kindness. Leidy (1994) points out that “these actions are the therapeutic essence of nursing practice” (p. 279). As nurses assist persons in achieving need satisfaction, they may be helping them move toward healthier lifestyles. More attention must be directed toward health promotion and ways to help people engage in positive lifestyle choices. This study indicates that one’s basic need status may be related to the choices and decisions one makes regarding health-promoting self-care behavior. Nurses and other health care professionals are in a good position to assess and intervene to influence positive need satisfaction and thus healthy lifestyle choices.

NOTE

1. This study was partially funded by the Luci Baines Johnson Fellowship.

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