Health Needs Of Patients With Cholelithiasis Undergoing .
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 827-841Health Needs of Patients with Cholelithiasis Undergoing LaparoscopicCholecystectomySanaa Mohamed Alaa Eldin, Amna Yehia saad and Samira Saad Ali Abo El bakaMedical -Surgical Nursing Department, Faculty of Nursing, Alexandria University.AbstractBackground: Laparoscopic cholecystectomy is standard procedure for management of gallbladder stone.Gallstones (cholelithiasis) are the most common cause of biliary tract disease in adults. The educative roleof nurse is integral part of the care that is essential to patient satisfaction and positive outcomes.Objective: Identify health needs of patients with cholelithiasis who were undergoing laparoscopiccholecystectomy.Patients and Methods: A convenient sample of 100 adult patients with cholelithiasis who wereundergoing laparoscopic cholecystectomy. Health needs of patients with cholelithiasis who we r eundergoing laparoscopic cholecystectomy included structured interview schedule was used to collect thedata for the present study. It included two parts about socio-demographic and clinical data, knowledgerelated to nature of the disease, pre- operative preparation, post-operative care and self- care followingdischarge.Results: the present study revealed that the majority of the studied patients had poor level of knowledge.There was statistically significant positive correlation between patients' level of knowledge and age,educational level, nurses as a source of knowledge and advices as well as physician and the nurse as apreferred source of knowledge.Conclusion: It was concluded that the studied patients had poor level of knowledge regarding diseasenature, pre-operative care, post-operative care and complications and self-care following discharge.Keywords: Health Needs, Cholelithiasis, Laparoscopic CholecystectomyIntroductionLaparoscopic cholecystectomy (LC) is theremoval of the gallbladder using a laparoscopictechnique. It is considered the Gold standardtreatment for symptomatic gallstone disease. It isconsidered one of the most common surgicalprocedures in western world. It has manyadvantages over open cholecystectomy in termsof minimal postoperative pain, shorter hospitalstay, early recovery, a rapid return to work, lessintra-abdominal adhesion, a better cosmeticoutcome and decrease in perioperative septiccomplications (1). The educative role of nursesfacilitate emancipation and empowerment aspatient gain confidence with self-care andprovision of information by nurses, a s s i s tpatient and families to cope with surgicalprocedure, promoting participation and creatingsupportive and educative environment (2) .Health needs of patients undergoing ormation related to preoperative education,which is an important part to improve post-operative period and prevent post-operativecomplications. In addition, provision ofinformation related to postoperative periodincludes post-operative pain management,exercise, nutrition, activity and follow up forevaluation of the care. This post-operative careis very important to prevent post-operativecomplications that lead to post-operativemortality and prolonged hospital stay, decreasefunctional and cognitive status and has a hugeimpact effect in hospital costs (3) .The aim of this study was to identify healthneeds of patients with cholelithiasis undergoinglaparoscopic cholecystectomy.Patients and MethodsThis study was conducted at the Hepato-biliarySurgical Department of Alexandria MainUniversity Hospital. A Convenient sample of 100adult patients with cholelithiasis who underwentlaparoscopic cholecystectomy and meeting thefollowing criteria:827Received: 11/10/2018Accepted: 30/10/2018
Health Needs of Patients with Cholelithiasis Undergoing Laparoscopic Cholecystectomy Adult patients from age 21 to 60 years. Able to communicate verbally. Patient with confirmed diagnosis ctomy.the actual health needs related this subject. Thispart included six questions about:of cholelithiasis.The anatomical location of gallbladder.The function of gallbladder.Possible and risk factors:As (age, heredity, obesity, fatty diet,dyslipidemia, diabetes mellitus, liver cirrhosis,hemolytic anemia, crohn’s disease, cysticfibrosis, metabolic syndrome, estrogen and oralcontraceptives method.Signs & Symptoms:This included data about patients' knowledge onthe signs and symptoms of cholelithiasis as righthypochondrial pain, GIT disturbance, fever,dyspepsia, jaundice and fatigue.Indication of cholecystectomy:It included data about patients' knowledge aboutindication of cholecystectomy as inflammation ofgallbladder, asymptomatic and symptomaticcholelithiasis, pancreatitis caused by gallstones,and risk for gallbladder cancer.B- Health needs of preoperative preparation:This item was structured to assess patient'slearning needs related to preoperative care. Itincluded questions about:Type of iccholecystectomy.Pre-operative preparation: This includedseven questions to assess patient's knowledgeabout preoperative preparation as preoperativeinvestigation and diagnostic tests, preoperativeinformed consent, stopping medication, such asanticoagulant drugs, duration of fasting beforesurgery, allergy from medication, type ofanesthesia, the importance and technique of deepbreathing and coughing exercises, surgicalincision site skin care, and duration of operation.C- Health needs of Post-operative care:This included nine questions to assess patient'sknowledge about post-operative knowledge as:Tools of data collection:One tool was utilized for the purpose of edinterviewschedule).It was developed by the researcher based on thereview of relevant literature to assessthepatient's health needs of patients withcholelithiasisundergoing laparoscopiccholecystectomy. It was comprised of two parts:Part I: This part was divided into two sections:1-Socio-demographic data:This part was used to collect patient'spersonal data such as: sex, age, educationallevel, occupation, marital states, area of residenceand income.2- Clinical data:It was utilized to obtain information aboutclinical history of the patients and theirfamilies.It included data related to patient’s diagnosis, pastand present medical history or any other healthproblems, previous hospitalization, duration ,surgicalhistory,familyhistory, present complaints (current symptoms),and anthropometric measurement weight,height, BMI.Part II: Health needs of patients withcholelithiasis undergoing laparoscopiccholecystect-omy:This part composed of four main items withthirty-nine questions with fixed alternatives. Itwas used to assess patient’s knowledge inrelation to the following items:A- Health needs related to nature of thedisease.This item was structured to assess patients'knowledge related to cholelithiasis, and determine1- Post-operative period: Five questions abouttime of early ambulation and its importancepostoperatively.828
Sanaa Alaa Eldin et al.Post-operativepreventivehealthbehaviors: Two questions about preventivehealth behavior as early ambulation and the timeto start it, change the position, leg exercise,breathing exercise and wearing elastic stocking.hepatic bleeding and infection of abdominalcavity (peritonitis).4- Self-care following discharge: It includedeight questions to assess patient knowledgerelated to:Post-operative Food and fluid intake: Itincluded two questions related to the time ofstarting oral fluids, time of oral feeding, and thesuitable type of food to start with after surgery.Post-operative medications: It included onequestion that was structured to assess patient'sknowledge related to postoperative requiredmedications actions.Post-operative pain controlling assplinting stomach by placing pillow overabdomen before coughing, distraction by focus onother activities, listening to music, playing gamesor other engaging activities, guided imagery,pursed lip breathing and taking of prescribedanalgesia.Type of therapeutic diet after dischargeas reduced fatty diet, increase fluid 2.5:3L/day,increase proteins, and vitamins.Care of wound after discharge as keepingwound clean and dry, following wound dressingschedule, if there was bleeding from the woundand checking the wound daily for any signs ofinfection (redness, pain, swelling, abnormaldischarge).Time of return to activity of daily living.Calling or visiting the physician whenthere was symptoms as a sudden pain at the siteof surgery, fever, GIT bleeding, increasedrainage from incision, delaying of bowelmovement for three day and severe calf musclepain.Post-operative follow up visits.D- Preferred source of knowledge, advicesand preferred methods of learning.This item was composed of three questions withfixed alternatives. It was used to assess patientpreferred source of knowledge as doctors,nurses, relatives, other patients, media andpreferred methods of knowledge & advices aswritten, oral, photos.2- Post-operative drains and catheter: Itincluded seven questions that structured to assesspatient's knowledge related to:Types of drains and catheters as wound drainand foley’s urethral catheter.Importance of wound drains that remove fluidand blood formation.Care of wound drain as dressing under aseptictechnique, keep the drainage system closed, keepthe site of wound dry, the tube not kinked, don’tsleep on it and check amount and color of drainageoutput.Time of removing wound drain.Importance of foley’s catheter as collectionand measurement of urine output.Care of foley’s catheter as keeping drainagesystem closed, keeping urinary bag under levelof urinary bladder, holding beside patientthigh, perineal care, increase fluid intake,observation of amount and color of urine outputand not to kink the tube.Time of removing foley’s urinary catheter.3- Post operative complications: It includedtwo questions to assess patient's knowledgerelated to:Scoring systemComplications from long period of immobilityas muscle weakness, dizziness, breathingdisorder, DVT, urinary retention, pressure soreand kidney stonesA score of two were given to each correctanswer, one for incomplete answer and zero forincorrect or not know. A total score of each areawas calculated and classified as the following:Scoring of less than 50% considered as poor.Scoring of 50% to 64% considered as fair.Scoring of more than or equal 65% consideredas good.Complications related to laparoscopy as bileduct injures, clip displacement, bile leakage,829
Health Needs of Patients with Cholelithiasis Undergoing Laparoscopic CholecystectomyAfter securing the administrative approval,the data collection was started.After securing the administrative approval andthe final draft of the structured tool t h a t wasused to collect data in order to achieve theobjective of this study, the data were collected byresearcher for each patient using individualizedinterview.The interview ranged from 30-45 minutes onindividual session.Data were obtained in morning and afternoonshift.The body mass index (BMI); an indexcalculated by a ratio of weight in kilograms toheight in square meters and used as a measure ofobesity. It was then calculated using the followingequation: BMI weight (kg) height (m2).Parameters have been established to delineateunderweight, normal weight and overweight.Body mass index categories: 18 underweight,18.5 to 25 desirable or normal weights, 25 to 30 overweight, 30 to 40 obese and over 40considered severely obese.2-MethodThe study was accomplished as follows:1- Written approval:Official approval to carry out the study wasobtained from the hospital responsible authoritiesat the previously mentioned research settings toobtain their permission to collect necessary data.An official permission was obtained from thedirectors and head of the departments of theselected hospital setting after explanation the aimof the study.2- Development of the study tool:The study tool was developed by the researcherafter extensive reviewing of relevant literature.The content of constructed tool was revised by ajury of 5 experts in the field of Medical SurgicalNursing Department of the Faculty of Nursing atAlexandria University to test content validity,completeness, and clarity of items. Commentsand suggestions of jury were considered and thetool was modified accordingly.7- Ethical considerations:- Written informed consent was obtained frompatients participating in the study.- Confidentiality of data and patient had the rightto withdraw at any time in the study and this wasemphasized to subjects of the study.- The anonymity and Privacy of patients wereascertained. The study was approved by theEthics Board of Alexandria University.3- Section 3 from part 2 in the developedtool was used for patients undergoing surgery.4- Reliability:The reliability of the developed tool was testedby using Alpha Cronbach's statistical test. Thetool for the study was applied to fifteenpatients. Reliability coefficient value was 0.8,which is acceptable.8- Statistical analysis:Data analysis was carried out using the StatisticalPackage of Social Sciences (SPSS, ver18). Datawere coded, entered and code checked beforeanalysis. For qualitative variables, data werepresented using numbers and percentage fromtotal. On the other hand, mean and standarddeviation were used to present the quantitativevariable (age).5- A pilot study:A pilot study was conducted on fifteen patients totest clarity, feasibility, and applicability of thestudy tool, and then necessary modifications weredone. Patients included in the pilot study wereexcluded from the study.6- Data collection:Results830
Sanaa Alaa Eldin et al.Table (1): Socio demographic criteria of the studied patientsSocio demographic characteristicsFrequency n 100GenderMaleFemaleAge20 3030 4040- 50Marital lMonthly incomeEnoughnot 7.011.0297129.071.04964.096.0Regarding gender, it was found that 64% of the studied patients were females. In relation to age, 47% ofthe studied patients were in the age group (40-50) years old. In addition, 79% of the studied patientswere married, and 71% lived in rural area. Moreover, it was found that 96% of the studied patients hadnot sufficient monthly income to fulfill the daily requirements as shown in table (1)Table (2): The distribution of the studied patients according to disease historyDisease historyFrequency n 100How did the patient know of having cholelithiasisAt onset of symptoms are increasedWhen the severity of symptom increasedAccidentally during a follow-up with the doctorDuration of illnessLess than 3 months3-6 monthsMore than 6 monthsThe symptoms complained as a result of cholelithiasisRight hypochondriac PainGIT disturbancesDyspepsiaRight hypochondriac Pain, dyspepsiaJaundiceFeverFeeling better with 51.048.0
Health Needs of Patients with Cholelithiasis Undergoing Laparoscopic CholecystectomyThis table showed that 40% of the studied patients were diagnosed at the onset of disease. It was found that49% had less than three months duration of cholelithiasis disease. Regarding symptoms related tocholelithiasis, it was observed that 46% suffered from right hypochondrial pain and dyspepsia.Table (3): The percentage distribution of the studied patients according to their knowledge regarding tohealth needs of pre-operative preparationHealth needs of preoperative preparation (n 100)IncorrectThe types of surgical treatmentThe important preparations andinstructions necessary before surgeryThe importance of breathing exercisesThe procedure of breathing exercisesThe importance of limb exercisesProcedure of post-operative leg 41042530NCorrect incomplete%Correct 2.05.04.0Regarding type of surgery to be performed, table (3) showed that 40% of studied patients did not know orgave a wrong answer about the type of surgery. In relation to pre-operative preparation and teaching beforesurgery, 54% of studied patients did not have knowledge about pre-operative preparation before surgery.Concerning importance of post-operative exercise, it was observed that all studied patients did not know theimportance of breathing exercise and its technique. Regarding importance of post-operative limb exercise,it was found that 70% of the studied patients gave wrong answer or did not know. Considering post-operativeleg, forearm exercises techniques, it was obvious that 66% of the studied patients gave wrong answer ordidn’t know.Table (4): The percentage distribution of studied patients according to their knowledge regarding healthneeds of post-operative careHealth needs of postoperative care(n 100)IncorrectN1- postoperative period:The postoperative preventive health behaviorsTime of moving after surgeryTime to start eating after surgeryPermissible foods after surgeryDrugs that can be taken after the operation?2- postoperative drains and catheter careKnow post-operative drain and catheters attachedKnow the importance of Foley urethral catheterCare of Foley urethral catheterTime of Foley urethral catheter removalThe importance of wound drainCare of wound drainTime of wound drain removal3- postoperative complications:Complications of long periods of immobilityComplications of laparoscopyRegarding the preventive health behaviors toprevent complications that include (earlymobility, change position frequently, breathingCorrect incomplete Correct .017.04.010.021.012.03.0121.02.04102112exercise, leg exercise and wearing elasticstocking), it was observed that 74% of the studiedpatients reported correct incomplete answer. In832
Sanaa Alaa Eldin et al.relation to start mobility after surgery, it wasdrain and catheter after Surgery. In relation to thefound that 83% had correct incomplete answer.importance of Foley’s catheter, it was observedConcerning the time to start eating after surgery,that 77% of the studied patients gave wrongmost of the studied patients knew correct andanswer or did not know. Concerning the care andincomplete answer. 80% of the studied patientsthe time of removal of Foley’s catheter, thegave correct incomplete knowledge about themajority of studied patients gave wrong answer orfood intake allowed after surgery. In relation todid not know. Finally, table (4) revealed that 83%post-operative drug, it was observed that 70%of studied patients had correct incomplete answerof studied patients gave correct incompleteabout complication of surgery from long period ofanswer. As regards knowledge about theimmobility. On the other hand, majority of thempostoperative drains and catheter, it was obviousgave wrong answer or did not know the answerthat no studied patients knew about the attachedabout the complication of laparoscopy.Table (5): The percentage distribution of the studied patients according to their knowledge regardingself-care following discharge.Self-care following discharge (n 100)IncorrectNControl of post-operative painTherapeutic diet after dischargeCare of the wound after dischargeAbility to return to ADLAbility to return to workThe situations that require contact of the doctorReturn to regular follow upFollow-up visits after the operation2449149393289333Correct incomplete Correct 5.05.013.03.016.0Regarding to control of post-operative pain, 67.5% of the studied patients gave correct complete answer.Concerning the therapeutic diet after discharge, 51% reported complete correct answer. In addition, table(5) showed that 93% did not know or informed wrong answer about the ability to return to ADL and tothe work. Regarding the situation that requires contact of the doctor, 59% of the studied patients reportedcorrect incomplete answer. In relation to return to regular follow up, it was obvious that 93% did not knowor informed wrong answer. Finally, this table revealed that 51% of studied patients had correct incompleteanswer about follow- up visits after operation.Table (6): The percentage distribution of the studied patients according to source of knowledge andadviceSource of knowledge and advices n 100NoN114476824The doctorNurseRelativesPatientsMediaPreferred source of informationThe doctorNurseRelativesPatientsMediaPreferred health education methodWrittenOralWritten, oralPhotos and 9148.090.09.014.0
Health Needs of Patients with Cholelithiasis Undergoing Laparoscopic CholecystectomyThis table revealed that physicians were the main source of advice and knowledge for 99% of patients. Inaddition, they were the main preferred source to give advice or knowledge for 97% of patients and 90%preferred oral methods.Table (7): The relation between knowledge level and characteristics of the studied patientsPatients’CharacteristicKnowledge levelPoor n 88Fair n 8N%nTotalMonte Carlo testGood n 4%N%Age (years)20 3030 4040 509354481.883.393.624218.29.54.30310.07.12.111 (100%)42 (100%)47 (100%)2X 4.6P 0.33SexMaleFemale325688.987.5358.37.8132.84.736 (100%)64 (100%)2X 0.223P 1.0Marital 4100.007100.08.914.30.003100.03.814.30.03 (100%)79 (100%)7 (100%)11 (100%)2X 4.41P 0. 52Residence areaUrbanRural187062.198.67124.11.44013.80.029 (100%)71 (100%)2X 26.2P 0.00*IncomeEnoughNot enough0880.091.71725.07.33175.01.04 (100%)96 (100%)2X 57.7P 0.00**statistically significant at P 0.05This table revealed that there was statistically significant positive correlation between patients' knowledgelevel and residence area (p 0.00) and income (p 0.00).Table (8): The relation between knowledge level and source of knowledge among the studied patientsSource of knowledge Patients level of knowledgePoorFairand advicesn 88n .0Yes6788.2810.5*statistically significant at P 0.05834TotalMonte Carlo testGoodn 4N%040.04.01 (100%)99 (100%)2X 0.14P 1.04028.60.014 (100%)86 (100%)2X 26.4P 0.00*316.41.947 (100%)53 (100%)2X 7.4P 0.02*405.90.068 (100%)32 (100%)2X 3.7P 0.193112.51.324 (100%)76 (100%)2X 8.2P 0.02*
Sanaa Alaa Eldin et al.Table (8) revealed that there was a statisticallysignificant positive correlation between patients'knowledge level and nurse advices (p 0.00),media (p 0.02) and relatives (p0.02). On theother hand, it was noticed that there was nosignificantcorrelationbetweenpatients'knowledge level from the doctors and patients. Itwas revealed in table (9) that there was astatistically significant positive correlationbetween patients' knowledge level and nurses aspreferred source of knowledge and advices (p 0.00). In addition, there was a statisticallysignificant positive correlation between patients'knowledge level and written & oral method ofhealth education as preferred method (p 0.01).Table (9): The relation between knowledge level and preferred source among the studied patientsPreferred Source of Patients level of knowledgeknowledgePoorFairn 88n 8nDoctorNoYesNurseNoYesRelativesNoYes%TotalMonte Carlo testGoodn 4N%N%385100.087.6080.08.2040.04.13 (100%)97 (100%)2X 0.42P 1.0107866.791.8176.78.24026.70.015 (100%)85 (100%)2X 23.6P 0.00*88088.00.0808.00.0404.00.0100 (100%)0 (100%)88.00.0808.00.0404.00.0100 (100%)0 (100%)88.850.0717.150.0404.10.098 (100%)2 (100%)2X 4.9P 0.0988.087.5717.612.5404.30.092 (100%)(100%)2X 0.57P 1.080.088.92620.06.7040.04.410 (100%)90 (100%)2X 2.5P 0.2391.255.6444.444.4404.40.091(100%)9(100%)2X 17.8P 0.01*89.578.6535.821.4404.70.086 (100%)14 (100%)2X 4.5P 0.17PatientsNo88Yes0MediaNo87Yes1Preferred method of educationWrittenNo81Yes7OralNo8Yes80Oral & WrittenNo83Yes5Photographs and graphicsNo77Yes11*statistically significant at P 0.05835
Health Needs of Patients with Cholelithiasis Undergoing Laparoscopic CholecystectomyDiscussionLeotine (11) who reported that most ofparticipants were illiterates.The findings of the present study indicated thatthe majority of the studied patients had poorknowledge level regarding gallstones nature andits management. Therefore, those patients musthave health needs toward risk factors ofdisease,treatment modalities cations and self-care following dischargeafter surgery. Most of the studied patientsreported that physicians and the nurses were thepreferred source of knowledge. In addition,there were high statistically significantdifferences that were found between patients'knowledge level and age and educational level,as well as positive relation was found betweenpatients' knowledge level and nurse advices.In relation to the area of residence, the presentstudy showed that the highest percentage ofpatients came from rural areas. This might berelated to lack of education, poor knowledge,poor sanitation and insufficient income withhigh risks of gallstones. This agreed withNaeem et al. (12) who found that the majority ofthe studied patients lived in rural area wherehealth care facilities were not available or werevery primitive.Regarding marital status, it was noticed that themajority of the studied patients were married.These findings revealed association betweenmarital status and gallstones because multiparaous women are risky for gallstones. This issupported with the study of Channa et al. (13)who demonstrated that in females, the marriageat earlier age was positively associated withhaving gallstone diseases and t h e earlymarriages can lead to longer fertility periodsand higher parity rates. Therefore, the femalesex hormones due to fertilities can playexcusive role for gallstone.Regarding age, the results of the present studyrevealed that more than half of the studiedpatients were in the age group between 30-50years old. This finding agreed with Nidoni (4) ashe found that the incidence of cholelithiasisincreases sharply with age which indicates thataging is one of the strongest and most prevalentrisk factor for cholelithiasis. This was attributedto that as age increased, the incidence ofmetabolic syndrome is increased, which isclosely related to the occurrence of gallstones.This finding also lined with Panpimanmas etal. (5) who mentioned that high prevalence ofgallstones occur with progression of age.In relation to family income, it was noticed thatthe majority of the studied patients hadinsufficient income to fulfill their dailyrequirement. This might be related to increasedpoverty and unemployment in Egypt especiallyin rural areas. These findings agreed with thestudy of Lu et al. (14) and Hung et al. (8) whoreported association between cholelithiasis andlow economic state. Therefore, the majority ofthe studied patients were under the umbrella ofUniversity free hospital.Concerning gender, this study showed that,more than half of the studied patients werefemales. This finding is supported by Khalaf etal. (6) who stated that the females have higherrisk of cholelithiasis than males. Additionally,this result agreed with Bass et al. (7) and Hunget al. (8) who found that most of their studiedpatients were females, who had a higherprevalence of gallstones, which could be due tomenopause, as a risk factor of gallstones inwomen 50 years old. They added that estrogenlevels increase the saturation of cholesterol inbile and in turn enhances the formation ofgallstones. Also, similar studies by Kim et al. (9)reported the same results.Regarding medical history of cholelithiasis,this finding showed that most of patients withcholelithiasis discovered symptoms of diseasefrom 3-6 months when the severity of symptomsincreased. This respected with the result ofMertens et al. (15) who reported that patientshad complained of cholelithiasis symptoms suchas biliary pain, nausea, vomiting and dyspepsialess than 6 month. However, the study ofTornqvist (16) contradicts this finding andreported that patients with cholelithiasis hadnot any experience of symptoms and consideredan incidental finding discovered accidentlyduring abdominal ultrasound. Moreover, theAs regards educational level, this study showedthat, most of the patients were basic andsecondary educated. This finding is supportedby Alishi et al. (10) as they reported that mostof their studied patients for cholelithiasis wereeducated. However, it was inconsistent with836
Sanaa Alaa Eldin et al.study mentioned that the most commonsymptoms of cholelithiasis were righthypochondrial pain, dyspepsia and fever. Thisresult is supported with the study of Sharadaet al. (17).emphasized about the importance of breathingand leg exercise post operatively. In addition,the current study showed that most of studiedpatients had unsatisfactory level of knowledgeabout the time for starting mobility aftersurgery. Additionally, this finding agreed withChatterley (23) who stated that patients need tounderstand the time and the benefits of earlymobilization for positive impact on ation. So, the nurse should encourageeducational program that may increaseprioritization of early mobilization in nursingcare of post-operative patients.In relation to knowledge of the studied patientsregarding t
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Needs lower down in the hierarchy must be satisfied before individuals can attend to needs higher up. From the bottom of the hierarchy upwards, the needs are: physiological, safety, love and belonging, esteem and self-actualization. Deficiency needs vs. growth needs This five-stage model can be divided into deficiency needs and growth needs.
2. To obtain the Dimensions of Existential Relatedness and Growth needs. 3.Erg Motivational Needs (Alderfer's Erg Model): The acronym ERG stands for three groups of fundamental needs, they are Existential, Relatedness and Growth needs. These needs are line up with the Malow‟s hierarchy of needs. But Alderfer developed the needs into a
