Whole-person care: First aid stabilises immediate threats, but safe nursing and physiotherapy care also responds to the person’s physical comfort, body functions, emotions, relationships, beliefs, independence and environment. Needs change with age, diagnosis, disability, culture and the stage of recovery.
Add an image showing holistic assessment of physical, physiological, psychological and social needs here.
Learning outcomes
- Define patient needs and explain why they must be assessed holistically.
- Differentiate physical, physiological, psychological and social needs while recognising that they overlap.
- Apply a safe, respectful and person-centred assessment in basic nursing procedures.
- Prioritise needs using ABCDE, Maslow’s hierarchy and clinical urgency.
- Plan, implement, document and evaluate care with the patient and family.
1. Meaning of patient needs
A patient need is a requirement whose absence threatens life, health, comfort, function, dignity or participation. Needs may be stated directly—“I cannot breathe” or “I am afraid”—or inferred from observation such as pallor, guarding, withdrawal, poor hygiene, unsafe mobility or inability to eat. Assessment is continuous: a need that is urgent at admission may become a rehabilitation or discharge need later.
2. The four broad groups of needs
| Group | Examples | How a caregiver recognises it |
|---|---|---|
| Physiological | Airway, breathing, circulation, temperature, oxygenation, glucose, fluids, nutrition, elimination, sleep and pain relief | Vital signs, intake/output, skin, consciousness, appetite, urine/stool pattern and the patient’s report. |
| Physical | Mobility, positioning, hygiene, skin integrity, dressing, exercise, assistive devices and protection from injury | Inspection, movement, strength, balance, pressure areas, ability to perform activities of daily living. |
| Psychological | Safety, information, reassurance, privacy, coping, hope, grief, control and freedom from humiliation | Words, facial expression, sleep, behaviour, mood, anxiety, questions and willingness to participate. |
| Social | Family contact, communication, culture, finances, housing, work/school roles, spiritual support and discharge resources | Ask what support is available and what barriers may prevent treatment or follow-up. |
3. Prioritising needs
- Immediate life threat: danger, airway obstruction, abnormal breathing, catastrophic bleeding, shock, severe hypoglycaemia or cardiac arrest.
- Time-sensitive deterioration: chest pain, stroke signs, altered consciousness, sepsis, severe pain, compartment syndrome or rapidly worsening swelling.
- Basic physiological stability: hydration, nutrition, temperature, elimination, sleep, pain and medication safety.
- Safety and function: falls prevention, pressure injury prevention, mobility, transfers, splinting and assistive equipment.
- Psychological, social and discharge needs: understanding, consent, family support, transport, finances and continuity of care.
Clinical rule: Maslow helps organise needs, but an apparently “lower” need can become urgent. A patient’s fear, language barrier or safeguarding concern can directly affect consent and safety.
4. Physical and physiological needs in practice
| Need | Assessment questions/observations | Basic nursing response |
|---|---|---|
| Airway and breathing | Can the patient speak? Is breathing noisy, fast or laboured? Is there cyanosis? | Position safely, call for help, provide trained first aid and monitor continuously. |
| Circulation and perfusion | Pulse, skin colour, temperature, capillary refill, bleeding, dizziness | Control bleeding, reduce exertion, maintain warmth and escalate deterioration. |
| Pain and comfort | Site, severity, character, onset, triggers, effect on sleep and function | Position, support, explain procedures, administer prescribed treatment and reassess. |
| Nutrition and fluids | Appetite, swallowing, weight change, vomiting, diarrhoea, hydration and diet restrictions | Offer appropriate assistance, record intake, refer swallowing or nutrition concerns. |
| Elimination | Urine amount/colour, bowel pattern, continence, pain or retention | Privacy, toilet access, hydration plan, monitoring and referral for abnormal findings. |
| Mobility and skin | Strength, balance, gait, pressure areas, wounds and equipment needs | Safe transfers, repositioning, pressure care, exercise within plan and falls prevention. |
| Rest and sleep | Sleep pattern, pain, noise, anxiety, breathlessness and medication effects | Cluster care, reduce disturbance, address symptoms and maintain a safe environment. |
5. Psychological needs
- Safety: explain who you are, what will happen and how the patient can call for help.
- Control: offer choices where clinically safe—timing, position, clothing, interpreter and support person.
- Information: use plain language, short steps, teach-back and written instructions when appropriate.
- Privacy and dignity: screen the area, expose only what is necessary and ask permission before touch.
- Emotional support: listen without judgement, acknowledge fear and avoid false reassurance.
- Mental-health safety: ask directly and calmly about self-harm when indicated; escalate risk rather than promising secrecy.
6. Social, cultural and spiritual needs
Ask who the patient considers family, what language they prefer, who may receive information and whether cultural or spiritual practices affect care. Never assume that a relative can interpret accurately or that a patient wants family present. Obtain consent before sharing information. Consider transport, money, housing, work, school, disability access and the ability to obtain medicines or attend follow-up.
7. Communication and consent
- Introduce yourself and confirm identity using approved identifiers.
- Explain the purpose, steps, expected sensations, benefits, risks and alternatives in language the patient understands.
- Check capacity and voluntariness. A person may refuse a procedure; document refusal and escalate when safety is at risk.
- Use a professional interpreter when needed. Do not rely on a child for sensitive information.
- Gain consent before examination, touching, photography or sharing information, and maintain confidentiality.
8. Person-centred care cycle
| Stage | Key action | Example |
|---|---|---|
| Assess | Collect subjective and objective information. | Patient reports dizziness; pulse is rapid and skin clammy. |
| Identify | State the priority need and contributing factors. | Risk of poor perfusion related to fluid loss. |
| Plan | Set measurable, patient-centred goals. | Patient will remain safe, warm and monitored while urgent review is arranged. |
| Implement | Provide care within scope and local protocol. | Position safely, control bleeding, call senior help and explain each step. |
| Evaluate | Reassess response and modify the plan. | Repeat observations and record whether dizziness and pulse improve. |
9. Scenario
Scenario: An older patient recovering from a fracture refuses mobilisation and appears withdrawn. Assessment: pain, fear of falling, low mood, poor sleep, unfamiliar language and lack of family transport may all contribute. Plan: treat pain as prescribed, explain the purpose, use an interpreter, involve the patient in setting a small mobility goal, provide safe equipment and discuss discharge support with the multidisciplinary team.
Exam points and revision questions
- Differentiate physiological, physical, psychological and social needs.
- Explain how ABCDE and Maslow can be used together.
- List six actions that protect privacy and dignity.
- Describe how culture, language and finances can affect treatment adherence.
- Write a short person-centred care plan for a patient with pain and impaired mobility.