1. Chapter 8: Human needs and human development

2. Learning objectives Identify basic human needs
Describe holistic care in healthcare
Explain why independence and self-care are important
Discuss different forms of sexual identity, including ways to accommodate sexual needs
Identify ways to help residents meet their spiritual needs
Identify ways to accommodate cultural and religious differences
Describe the need for activity
Discuss family roles and their significance in health care
List ways to respond to emotional needs of residents and their families
Describe the stages of human growth and development including common disorders for each stage
Distinguish between what is true and what is false about the aging process
List care guidelines for developmental disabilities
Identify community resources available to help the elderly and developmentally disabled

3. Basic Human Needs
Human beings have the following basic physical needs:
Food and water
Protection and shelter
Activity
Sleep and rest
Comfort, freedom from pain
Human beings have the following psychosocial needs:
Love and affection
Acceptance by others
Safety and security
Self-reliance and independence in daily living
Contact with other people
Success and self-esteem
When psychosocial needs are not met, people may experience the following:
Frustration
Stress
Fear
Anxiety
Anger
Aggression
Withdrawal
Depression

4. Holistic care Holistic care
Holistic care is a type of care that involves caring for the whole person – the mind as well as the body. NAs must provide for resident needs by providing this type of care. We must consider psychosocial factors as well as physiological factors when caring for residents.
Residents in an LTCF may be experiencing any or all of these losses:
Loss of spouse, family, or friends
Loss of workplace and its relationships
Loss of ability to go places
Loss of ability to attend religious services and meetings
Loss of home and personal possessions
Loss of health and ability to care for themselves
Loss of ability to move freely
Loss of pets
Understanding that residents are multi-faceted – with mind, body, and spirit – will help the NA provide holistic care.

5. Independence and self-care
Loss of independence
Promoting independence
Any big change in lifestyle, such as moving into a LTCF, requires a huge emotional adjustment. Residents may be experiencing fear, loss, and uncertainty, along with a decline in health and independence.
Loss of independence may cause the following difficulties for residents:
Poor self-image
Anger
Feelings of helplessness, sadness, and hopelessness
Feelings of uselessness
Increased dependence
Depression
NAs can assist residents by promoting independence in these ways:
Encourage residents to do as much as possible for themselves, no matter how long it takes (self-care)
Be patient.
Allow residents to make choices (ex.: would Mrs. Smith like to take her bath before or after breakfast?; Would Mr. Jones like to eat breakfast in the dining room or have his meal brought to his room?)
Remember: NAs must never treat residents like children. They must respect the fact that residents can make their own choices, and always encourage residents to care for themselves.

6. Sexual identity and ways to accommodate sexual needs
In addition to the needs discussed earlier, people also have sexual needs. These needs continue throughout their lives. The ability to engage in sexual activity, such as intercourse or masturbation (the touching or rubbing of sexual organs in order to give oneself or another person sexual pleasure) continues unless a disease or injury occurs.
Residents have the right to choose how they express their sexuality and to define their sexual orientation (a person’s preference for one gender (male or female) or the other, or both.
Heterosexual (straight) – a person whose sexual preference is for people of the opposite sex
Homosexual (gay or lesbian) – a person whose sexual preference is for people of the same sex
Bisexual – a person who is sexually attracted to both men and women
Transsexual – 2 definitions:
1. One who wishes to be accepted by society as a member of the opposite sex
2. One who has undergone a sex change operation
Transgender – a person whose gender identify conflicts with his or her birth sex (sex assigned at birth due to anatomy)
Transitioning – the process of changing genders
Remember: No matter what an NA’s feelings about LGBT people may be, they must respect all residents and their choices.
NAs must respect residents’ sexual needs, remembering these points:
People continue to have sexual needs throughout their lives.
Humans express their sexuality through different behaviors.
Knock and wait for a response before entering residents’ rooms.
Provide privacy if you encounter a sexual situation between consenting adults. Remove the resident from an unsafe situation and notify the nurse immediately if sexual abuse is observed.
Be open and nonjudgmental.
Honor Do Not Disturb signs.

7. Spiritual needs Spiritual Helping meet spiritual needs
Residents may have spiritual needs, and NAs can help with those needs. The word “spiritual” means of, or relating to, the spirit or soul.
NAs can help residents meet their spiritual needs in these ways:
Learn about their religion.
Respect residents’ decisions to participate in, or refrain from, food-related rituals. Assist with practices as requested (never make judgments).
Encourage participation in religious services for residents who are religious.
Respect all religious items.
Report requests to see clergy to nurse.
Get to know resident’s priest, rabbi, or minister.
Allow privacy for clergy visits.
If asked, read religious materials aloud.
Refer resident to spiritual resources if requested.
Nursing assistants should never:
Try to change someone’s religion
Tell residents their belief or religion is wrong
Express judgments about a religious group
Insist that residents join religious activities
Interfere with religious practices

8. Accommodate cultural and religious differences
Religions
Cultural and religious terms
Residents come from different cultural and religious backgrounds. A person’s religion often plays a part in his or her cultural practices.
The following religions and beliefs may be practiced by residents:
Buddhism
Christianity
Hinduism
Islam
Judaism
Spirituality
Native American spiritual traditions
Some terms related to culture, spirituality and religion:
Reincarnation – a belief that some part of a living being survives death to be reborn in a new body
Karma – the belief that all past and present deeds affect one’s future and future lives
Yarmulke – a small skull cap worn by Jewish men as a sign of their faith
Rabbi – religious leader of the Jewish faith
Dietary restrictions – rules about what and when individuals can eat
Fasting – not eating food or eating very little food
Vegetarians – people who do not eat meat, fish, or poultry and may or may not eat eggs and dairy products
Vegans – people who do not eat any animals or animal products; vegans may also not use or wear any animal products
Agnostics – people who believe that they do not know or cannot know if God exists
Atheists – people who believe that there is no God and actively deny the existence of God

9. Need for activity Activity Positive effects of activity
Negative effects of activity
Activity is an essential part of a person’s life; it improves and maintains physical and mental health.
The following are positive effects of physical activity:
Lessens risk of illnesses
Relieves symptoms of depression
Improves mood and concentration
Improves body function
Lowers risk of falls
Improves sleep
Improves ability to cope with stress
Increases energy
Increases appetite
Inactivity may cause the following problems:
Loss of self-esteem
Depression
Boredom
Pneumonia
Urinary tract infection
Constipation
Blood clots
Dulling of senses

10. Family roles Family types Functions performed by family
Adjustments made by family
Families play an important part in most people’s lives. The concept of family is always changing and each person has his or her definition of what family is.
NAs may encounter residents and family members from any of the following family types:
Nuclear families – two parents and one or more children
Single-parent families – one parent and one or more children
Married or committed couples of the same sex or opposite sex
Extended families – parents, children, grandparents, aunts, uncles, cousins, other relatives, and even friends
Blended families – divorced or widowed parents who have remarried and have children from previous relationships and/or the current marriage
Remember: A resident must never be denied the right to have the people he loves around him. Families of all descriptions make residents’ lives more meaningful and caregivers should always make residents’ families feel welcome.
Residents’ families may perform these functions in the care of the residents:
Helping to make care decisions
Communicating with care team
Giving support and encouragement
Connecting to outside world
Giving assurance to dying residents
Families of LTCF residents are likely experiencing significant and challenging adjustments, including the following:
Accepting the resident’s illness/disability and its consequences
Finding money to pay for hospitalization, long-term care, or home care
Dealing with paperwork
Taking care of tasks residents cannot handle
Understanding medical information and making care decisions
Caring for children while also caring for an elderly loved one

11. Emotional needs Three ways to respond to residents and families:
Listen
Offer support and encouragement
Refer the problem to a social worker or your supervisor
Residents or family members may come to NAs with problems or needs.
NAs should remember the following three ways to respond to residents and families:
Listen – Often just talking about a problem or concern can make it easier to handle. Sitting quietly and letting someone talk or cry may be the best help a nursing assistant can give
Offer support and encouragement – Avoid using clichés or dismissing the person’s feelings. Acknowledge the person’s feelings and express empathy
Refer the problem to a social worker or your supervisor – when a NA feels that he or she cannot help the resident, he or she should say something like, “Mrs. Jones, I think my supervisor would be better at getting you the help you need.”.

12. Stages of human growth and development
Childhood
Birth to 12 months
Ages 1 to 3
Ages 3 to 6
Ages 6 to 10
Common disorders of childhood
Pre-adolescence and Adolescence
Ages 10 to 13
Ages 13 to 19
Young adulthood
Ages 19 to 40
Middle adulthood
Ages 40 to 65
Late adulthood
Ages 65 years and older
NAs should be familiar with the following information regarding infancy (birth to 12 months):
Period of rapid growth and development
Development is from head down
Common disorders include the following:
Prematurity
Low birth weight
Birth defects
Viral or bacterial infections
Sudden infant death syndrome (SIDS)
NAs should be familiar with the following information regarding toddlerhood (ages 1 - 3):
Formerly dependent, now gaining independence and body control
Learn to speak, gain coordination and bladder and bowel control
May have tantrums or whine to get their way
NAs should be familiar with the following information regarding the preschool years (ages 3 - 6):
More social relationships
Play cooperatively and learn language
Learn right from wrong
NAs should be familiar with the following information regarding the school-age years (ages ):
Strong focus on cognitive development (thinking and learning)
Learn to get along with others in peer group
Develop a conscience and self-esteem
Common disorders of childhood (toddlerhood through school age) include the following:
Chickenpox
Leukemia
Child abuse or neglect
Vaccine-preventable illnesses (no longer common in developed countries):
Measles
Mumps
Rubella
Diphtheria
Smallpox
Whooping cough
Polio
NAs should be familiar with the following information regarding the preadolescent years (ages ):
Growing sense of self-identity
Strongly identify with peers
Relatively calm period
Imaginary fears give way to fears based in real world
NAs should be familiar with the following information regarding the adolescent years (ages ):
Marked by onset of puberty (age range is approximate)
Secondary sex characteristics appear
Reproductive organs begin to function
Concern for body and peer acceptance
Changing moods
Eating disorders (anorexia, bulimia)
STIs
Pregnancy
Depression
Trauma due to auto accidents or sports injuries
The following are the tasks associated with young adulthood (ages ):
Select an education
Select a career
Select and live with a mate
Raise children
Develop a satisfying sex life
The following are typical events of middle adulthood (ages ):
More comfortable and stable
May have “mid-life crisis”
Physical changes related to aging occur
The following may occur in late adulthood (65 years and older):
Many physical and psychosocial changes
Loss of physical health
Loss of friends and jobs
Common disorders:
Arthritis
Alzheimer’s disease
Cancer
Diabetes
Stroke

13. The truth about the aging process
Geriatrics
Gerontology
Ageism
Facts about aging
Normal and abnormal changes of aging
Geriatrics is the study of health, wellness, and disease in later life. Gerontology is the study of the aging process in people from mid-life through old age.
There are often false ideas about older people. Ageism is prejudice toward, stereotyping of, and/or discrimination against older persons or the elderly.
NAs should know the following facts about aging:
Older adults have many different capabilities.
Stereotypes are false.
Older persons are usually active.
Aging is a normal process, not a disease.
Aging persons need to adjust to change.
They do not need to be dependent.
Normal changes of aging include the following:
Thinner, drier, more fragile, and less elastic skin
Weaker muscles
Bones more brittle and lose density
Decreased sensitivity of nerve endings in skin
Slower responses and reflexes
Short-term memory loss
Changes in senses
Less efficient heart
Decreased oxygen in blood
Decreased appetite
More frequent elimination
Changes in hormone production
Weakened immunity
Change in lifestyle
The following are not considered normal changes of aging:
Depression
Inability to think logically
Poor nutrition
Shortness of breath
Incontinence

14. Developmental disabilities and care guidelines
Intellectual disabilities
Down syndrome
Cerebral palsy
Spina bifida
Autism
Developmental disabilities are disabilities that are present at birth or emerge during childhood that restrict physical or mental ability.
Intellectual disabilities – formerly called mental retardation and is the most common developmental disorder. These disabilities cause patients to have a difficulty with learning, communicating, moving, and may have problems adjusting socially. The main goal of care is to help the person have as normal a life as possible.
Treat adult residents as adults, regardless of their behavior
Praise and encourage often, especially positive behavior
Help teach the resident to perform ADLs by dividing a task into smaller units
Promote independence, but also assist residents with activities and motor functions that are difficult
Encourage social interaction
Repeat what you say to make sure they understand
Be patient
Down Syndrome – People with down syndrome have an extra chromosome in the 21st set. As with some types of intellectual disabilities, a person with Down syndrome can become fairly independent
Give the same type of care and instruction that you would for any other person with an intellectual disability
Cerebral palsy – People with cerebral palsy have suffered brain damage either while in the uterus or during birth.
Allow the resident to move slowly
Keep the resident’s body in as normal an alignment as possible
Talk to the resident, even if he or she cannot speak. Be patient and listen
Use touch as a form of communication
Avoid activities that are tiring or frustrating
Be gentle when handling parts of the body that may be painful
Promote independence and encourage socialization
Spina bifida – Spida bifida is caused by a failure of part of the backbone to form correctly and can cause a range of disabilities.
Provide assistance with range of motion exercises and ADLs
Be a positive role model for the resident and family in learning to deal with the resident’s disabilities
Autism – Autism is part of a group of developmental disorders called autism spectrum disorders. Autism appears in early childhood and continues throughout the person’s life. It causes problems with communication and social skills.

15. Community resources to help the elderly and the developmentally disabled
Where to find resources
Government and private agencies exist in most areas to serve the needs of the elderly. The internet or phone book lists these organizations under community services, senior citizens, aging, or elder services. Local churches or synagogues may also have programs for seniors. If residents ask a nursing assistant for help, the NA should refer them to the nurse or social worker.

16. Review Basic human needs Holistic care Independence and self-care
Spiritual needs
Cultural and spiritual practices
Family roles
Emotional needs
Human development
The truth about the aging process
Guidelines for caring for the developmentally disabled
Resources for the elderly and developmentally disabled
All humans have basic needs which must be met in order for them to live a fulfilled life. Holistic care assures that both physical as well as psychosocial needs are met. Residents have a need for independence, and allowing for self-care is one way that the NA can promote independence. Just like other needs, residents may have spiritual needs. The NA should work to promote spiritual wellness for residents and should honor the resident’s right to practice his or her cultural and/or religious practices.
Residents need to be kept as active as their condition allows. Activity has positive physical and well as psychological benefits.
Family is important to most people and plays many important roles in residents’ lives.
Emotional needs should be acknowledged and the NA should listen, offer support and encouragement, and refer the problem to a social worker or your supervisor.
The stages of human development were discussed and common disorders for each stage were outlined
There are many stereotypes and misconceptions regarding the aging process. Truths about aging were discussed.
Guidelines for caring for persons with developmental disabilities were discussed and places to find resources for the elderly and developmentally disabled were provided.