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Which is the first priority physiologic needs or safety?

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One of my residents is diagnosed with Schizophrenia. Most of the time she is confused, restlessness, sleepless, wandering, and anxious. She is a fall risk and bed alarm, chair alarm and personal monitor are used. One night her bed alarm was defected and chair alarm was used in its place. Chair alarm was so sensitive even with a slight move in the bed, it kept going off, annoyed and woke her up. I was worried that she would be aggitated from that annoying sound. In our nursing textbook, physiologic needs (oxygen, water,food, temp, elimination, sexuality, physical activity, and rest) are first priority and safety is second. When other options were not available like replace with another bed alarm or having maintenance to fix it, I wanted to remove the chair alarm to provide the resident with stimulation free environment so she could get a full rest. But when I asked other nurses, they would put safety first. If you were in my shoes what would you do?

Safety would definetly be first in this situation...who cares if the pt gets a good night sleep if she cracks her head open on the floor when she falls...use the bed alarm or if possible get a family member or paid sitter to stay with the patient instead

Spritenurse1210, BSN, RN

Specializes in Med/Surg.

I agree, safety first in this situation. She wont exactly get a good nights rest laying on the cold floor with broken bones. I would suggest, howeover just as Iggy123 has mentioned, seeing if a family member or private sitter can sit with her.

november17, ASN, RN

Specializes in Ortho, Case Management, blabla. Has 9 years experience.

safety.

Lets pretend you have blind patient with an spO2 of 70% walking towards the edge of a cliff. They don't realize they are about to fall 100 feet to their death - hey, they're blind. Also, they're acting funny and confused thanks to their low O2 sat, and with the next step they're about to go off the cliff.

There's two scenarios here.

A) You grab them and pull them from the edge of precipice. Then you run to the nearest tent or whatever and get them on O2.

B) You run and get the O2 but by the time you get back...it's a little too late, because they've already stepped off the edge.

Strictly adhering to maslow, the answer would be B. Because of course, their O2 sat is the priority here.

But fortunately as human beings we have flexibility as well as common sense. Which dictates that we'd pick A. However, that goes completely 100% against what maslow's hierarchy teaches. So ***?

Yes, the patient might not have rested very well, but a night of being woken up pales in comparison to the alternatives. Falls happen all the time and honestly a broken hip or subdural hemorrhage is much worse than getting a crappy night's sleep (especially for someone on fall precautions). I work ortho...this happens a few times a month at various nursing homes throughout the area. It can and at some point will happen to you. The people that told you "keep bed alarm on", its already happened to. I used to pride myself on the fact that I never had a patient fall while under my care, then it happened...my mantra is "never again." Just my humble opinion. Safety first.

Edited by november17

Emergency RN

Specializes in ED, CTSurg, IVTeam, Oncology. Has 30 years experience.

one of my residents is diagnosed with schizophrenia. most of the time she is confused, restlessness, sleepless, wandering, and anxious. she is a fall risk and bed alarm, chair alarm and personal monitor are used. one night her bed alarm was defected and chair alarm was used in its place. chair alarm was so sensitive even with a slight move in the bed, it kept going off, annoyed and woke her up. i was worried that she would be aggitated from that annoying sound. in our nursing textbook, physiologic needs (oxygen, water,food, temp, elimination, sexuality, physical activity, and rest) are first priority and safety is second. when other options were not available like replace with another bed alarm or having maintenance to fix it, i wanted to remove the chair alarm to provide the resident with stimulation free environment so she could get a full rest. but when i asked other nurses, they would put safety first. if you were in my shoes what would you do?

airway, breathing, and circulation, is the primary physiologic need that come ahead as first priority. all the rest takes a back seat to safety. i've had patients that were in four point restraints who were allowed to defecate on themselves because they were too violent and too much a danger to be let go at the moment. would i feed a patient such as that? obviously not until they're calmer; his safety comes first. rest? sure, but only if it's safe. getting a good night's sleep is very, very low against a metric of safety. would i try to provide for it? of course, but never at the expense of safety. again, the only things that supercedes safety imho, is the abc's of airway, breathing, and circulation. the rest of the alphabet will just have to wait.

sorry, but imho, you'll be taking a huge risk.

a) you grab them and pull them from the edge of precipice. then you run to the nearest tent or whatever and get them on o2.

b) you run and get the o2 but by the time you get back...it's a little too late, because they've already stepped off the edge.

strictly adhering to maslow, the answer would be b. because of course, their o2 sat is the priority here.

well, yes and no; stepping off a cliff would compromise airway, breathing and circulation. thus, by choosing to add o2 first to augment breathing, you've sacrificed all three primary physiologic needs. stopping the patient first, is still consistent with maslow's hierarchy, that of basic need (ie survival, which depends on airway, breathing & circulation). yeah, i know; it was a trick question, lol... :uhoh3:

Edited by Emergency RN

Perpetual Student

Specializes in PACU. Has 4+ years experience.

You have to remember that Maslow was a psychologist. He was thinking more about the feeling of security than the need for physical security to protect against immediate harm. SECURing essential physiological stability is more important than meeting non-emergent physiologic needs.

A better way to prioritize initially is "what will kill/injure the patient the most the quickest?"

For a goofy but clear example, suppose you were bagging a patient when the room burst into flames. Do you continue bagging the patient or do you wheel the patient out of the room first? Oxygen is a physiological need (an important one at that), but if you remain in the burning room that will be totally moot.

1. Physiological Needs- Food, Water, Shelter, Oxygen, Elimination, Sleep, Rest

2. Safety and Security

3. Love and Affection

4. Esteem

5. Self Actualization- Problem solver, one who meets all other needs first, confident, willing to accept criticism, self respect, reaches out to others

I say Safety comes first in this situation. Think about your license.

Whispera, MSN, RN

Specializes in psych, addictions, hospice, education.

Real life story (not mine, thankfully)....a person was knocked off a bicycle and required CPR. A good samaritan was performing CPR right where the person way laying. Both were hit by another car because no one moved the bicycle rider out of the path of traffic.

Safety comes first if it's an issue. Otherwise ABC...

that's a very good priority question. The first step in the nursing process is to "assess" and so forth. Safety would clearly be the priority. The O2 sats are a concern, but you would need a pulse ox to they are low.

Safety is not first because without the physical need of oxygen you cant live- therefore physiological needs must be met first.

Safety is not first because without the physical need of oxygen you cant live- therefore physiological needs must be met first.

The pt in question is schizophrenic and there was nothing said about him/ her needing oxygen or have difficulty breathing.

Thank you for all of you shareing valuable and knowledgable experiences. I will keep in mind that safety is first while I am trying to provide my resident with relaxable environment.

pinkiepie_RN

Specializes in General adult inpatient psychiatry.

If the bed alarm/chair alarm was being so obnoxious and they were a fall risk, I would have seen if I could put them in a geri chair or something outside of the nursing station so I could keep an eye on them.