Table of Contents
Type: Case Study | Subject: Nursing | Level: Undergraduate | Word Count: ~2,900 words
This model case study was produced by an Essays UK specialist as reference material for learning purposes only. For support in this field, see our nursing essay writing experts.
Overview: This model case study applies the Roper-Logan-Tierney model of nursing and the ADPIE process to the care of an anonymised, fictional patient living with Type 2 diabetes. It demonstrates how a recognised UK nursing framework can structure holistic assessment, diagnosis, planning, implementation and evaluation, and is provided purely as reference material to support learning.
This case study presents a model analysis of the nursing care provided to an adult living with Type 2 diabetes mellitus (T2DM), framed within the Roper-Logan-Tierney (RLT) model of nursing and the ADPIE (assessment, diagnosis, planning, implementation and evaluation) problem-solving process. In keeping with the professional standards on confidentiality set out by the Nursing and Midwifery Council (NMC, 2018), the person discussed here is entirely fictional and all identifying details have been altered; throughout, he is referred to by the pseudonym “David”. The case is constructed as illustrative teaching material and does not describe a real individual, nor should the clinical values cited be read as real-world data.
David is a 58-year-old man who was diagnosed with Type 2 diabetes approximately three months before this episode of care, following a routine review at his general practice. He lives with his wife in a two-storey terraced house and works full time as a long-distance delivery driver, a largely sedentary occupation that involves irregular mealtimes and a heavy reliance on convenience food. At the point of assessment by the community nursing team, David presented with an illustrative glycated haemoglobin (HbA1c) of 68 mmol/mol, a body mass index (BMI) of 32 kg/m², a blood pressure of 148/88 mmHg, and reported symptoms of fatigue, increased thirst and intermittent blurred vision. He expressed considerable anxiety about his diagnosis and uncertainty about how to translate the lifestyle advice he had been given into everyday practice.
The rationale for selecting the RLT model in this case is that Type 2 diabetes is a long-term condition whose management depends less on a single clinical event and more on how a person conducts the ordinary activities of daily life. A model that organises care around the activities of living therefore offers a natural fit, allowing the nurse to look beyond blood glucose figures to the social, psychological and economic realities that shape David’s self-management. The discussion that follows uses the RLT framework to structure a holistic assessment, and then applies the ADPIE process to demonstrate systematic, person-centred care.
The RLT model, first developed in the 1980s and refined in later editions, is one of the most widely taught nursing frameworks in the United Kingdom (Roper, Logan and Tierney, 2000). It is built around five interrelated concepts: the twelve activities of living (ALs); the lifespan; the dependence-independence continuum; the factors that influence the activities of living; and the principle of individuality in living. The twelve activities of living are maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling body temperature, mobilising, working and playing, expressing sexuality, sleeping, and dying.
A central strength of the model is that it does not treat these activities as a simple checklist. Instead, each activity is considered in relation to where the person currently sits on the dependence-independence continuum, and in relation to five influencing factors: biological, psychological, sociocultural, environmental, and politico-economic (Holland and Jenkins, 2019). This structure encourages the nurse to ask not only what a person can do, but why their ability to carry out an activity has changed and what would help them move towards greater independence. Applied thoughtfully, the model aligns closely with the person-centred, holistic care that the NMC (2018) expects of registered practitioners.
The ADPIE process provides the complementary problem-solving cycle that turns assessment into action. Assessment gathers and interprets information; diagnosis identifies the actual and potential problems; planning sets measurable goals and selects interventions; implementation delivers the agreed care; and evaluation judges whether the goals have been met and feeds back into further assessment (Barrett, Wilson and Woollands, 2018). Using the RLT activities of living as the lens for each stage of ADPIE produces a care plan that is both systematic and genuinely individualised, and it is this combined approach that the remainder of the case study follows.
A comprehensive assessment was undertaken across the twelve activities of living. Rather than describe each activity at equal length, the assessment prioritised those activities most affected by David’s diabetes while recording the others for completeness. The table below summarises the key findings and the position identified on the dependence-independence continuum for each affected activity.
| Activity of Living | Assessment Finding | Dependence-Independence |
|---|---|---|
| Eating and drinking | Irregular meals, high intake of refined carbohydrate and sugary drinks while working; limited understanding of carbohydrate awareness. | Partially dependent on education and support. |
| Mobilising | Sedentary occupation and low baseline physical activity; no mobility impairment but limited routine exercise. | Independent in function, dependent for motivation. |
| Maintaining a safe environment | Risk of hyperglycaemia and, once treatment intensifies, potential hypoglycaemia; reduced foot sensation not yet present but at future risk. | Dependent on knowledge and monitoring. |
| Communicating | Articulate but anxious; reports feeling overwhelmed by information given at diagnosis; blurred vision affecting reading of materials. | Largely independent, needs tailored information. |
| Working and playing | Shift patterns disrupt routine; little time or perceived opportunity for leisure or exercise; concern about driving and the condition. | Independent, with occupational barriers. |
| Sleeping | Reports broken sleep and nocturia linked to hyperglycaemia; daytime fatigue affecting concentration. | Partially dependent on glycaemic control. |
The remaining activities of living were assessed as broadly independent at this stage. Breathing, eliminating (other than the nocturia noted above), personal cleansing and dressing, controlling body temperature, expressing sexuality and dying did not reveal acute problems, although David raised a quiet concern about the long-term outlook of his diagnosis, which was acknowledged and recorded as an area for ongoing emotional support. Recording these activities as unaffected is itself a valuable part of the model, because it establishes a baseline against which later deterioration or improvement can be measured.
Interpreting the assessment through the five influencing factors deepened the picture considerably. The biological factor was the pathophysiology of Type 2 diabetes itself: insulin resistance and relative insulin deficiency producing the hyperglycaemia reflected in his HbA1c and symptoms. The psychological factor was prominent, as David’s anxiety and sense of being overwhelmed were directly reducing his capacity to engage with self-management. The sociocultural factor included the family mealtime patterns he shared with his wife and the social norms of his workplace. The environmental factor centred on the cab of his delivery vehicle and limited access to fresh food during long shifts, while the politico-economic factor encompassed his reliance on continued employment, the affordability of healthier food, and his access to primary care and structured education. Considering these factors prevented the care plan from reducing David’s situation to a problem of individual willpower and instead located it within a realistic set of constraints, consistent with current guidance on supporting self-management (NICE, 2022).
Synthesising the assessment produced a set of actual and potential nursing diagnoses. These were expressed in terms of the affected activities of living and the factors sustaining them, so that each diagnosis pointed naturally towards an intervention.
Prioritisation followed a logic of safety and sustainability. Immediate attention was given to glycaemic control and to the knowledge deficit that underpinned it, because improvement here would reduce symptoms and lower longer-term risk. Anxiety was addressed in parallel rather than deferred, since unmanaged anxiety would undermine every other intervention. The potential problems were documented so that they could be monitored proactively rather than managed only once they had become actual harms.
Goals were negotiated with David rather than imposed, reflecting the model’s emphasis on individuality and the NMC (2018) requirement to work in partnership with the people in one’s care. Each goal was framed using SMART principles (specific, measurable, achievable, realistic and time-bound), and short-term goals were deliberately modest so that early success could build confidence. The table below sets out the agreed plan.
| Problem | Goal (SMART) | Timeframe |
|---|---|---|
| Suboptimal glycaemic control | David will attend a structured diabetes education programme and agree two realistic dietary changes with the team. | Within 4 weeks. |
| Knowledge deficit | David will describe, in his own words, how to recognise and respond to high and low blood glucose. | Within 2 weeks. |
| Physical inactivity | David will build 30 minutes of walking into his routine on at least four days each week. | Within 6 weeks. |
| Anxiety | David will report a subjective reduction in anxiety and identify at least one source of ongoing support. | Ongoing, reviewed at 4 weeks. |
| Long-term goal | David’s HbA1c will move towards an individualised target agreed with his GP, with annual review of feet, eyes and kidneys arranged. | Within 3–6 months. |
The long-term glycaemic target was deliberately framed as individualised rather than fixed. Current national guidance recommends that HbA1c targets be agreed with the person and adjusted according to their circumstances and the medicines they take, rather than applying a single figure to everyone (NICE, 2022; SIGN, 2017). Framing the goal this way respected David’s autonomy and reduced the risk that an unrealistically strict target would increase his anxiety or his exposure to hypoglycaemia.
Implementation translated the plan into practical, evidence-informed interventions, each mapped back to an activity of living. The interventions are grouped below under the most relevant activities.
Rather than issuing a prescriptive diet sheet, the nurse used a brief, collaborative approach to dietary change. David was referred to a structured diabetes education programme and to a registered dietitian for individualised advice, in line with the recommendation that all adults with Type 2 diabetes be offered structured education at or around the point of diagnosis (NICE, 2022). In the interim, two achievable changes were agreed: swapping sugary drinks for water or no-added-sugar alternatives during shifts, and preparing a simple packed meal to reduce reliance on forecourt food. These small, concrete steps reflected evidence that modest, sustainable dietary change is more effective than wholesale restriction that is quickly abandoned (Diabetes UK, 2023). The practical barriers identified in the environmental and politico-economic factors, such as cost and availability on the road, were discussed openly so that the advice fitted David’s actual working day.
Physical activity was approached through David’s existing routine rather than as an additional burden. The team explored opportunities to walk during rest breaks and to use part of his lunch period for a brisk walk, building gradually towards the agreed goal of thirty minutes on most days. Because his occupation was sedentary and governed by schedules, the plan acknowledged the working and playing activity as an area of constrained independence and focused on realistic increments. The relationship between regular activity, weight, blood pressure and glycaemic control was explained in plain terms, connecting the intervention to outcomes David cared about, such as having more energy and sleeping better.
Addressing the knowledge deficit was central to safe self-management. Information was delivered in short, focused sessions rather than a single overwhelming conversation, and the teach-back technique was used so that David explained each point back in his own words, allowing the nurse to confirm understanding and correct misconceptions. Written materials were provided in a format he could read despite his blurred vision, and he was signposted to reputable sources of further information (Diabetes UK, 2023). Safety education covered the recognition of hyperglycaemia and hypoglycaemia, foot care and the importance of attending retinal screening, directly serving the activity of maintaining a safe environment. Given his role as a professional driver, particular care was taken to explain the implications of the condition and any future medication for driving safety, and he was advised to discuss these with his GP and the relevant authority as appropriate.
The anxiety diagnosis was addressed through a consistent, unhurried therapeutic relationship. The nurse used active listening and validated David’s feelings rather than dismissing them, which itself reduced his sense of being overwhelmed. Information was paced to his readiness, and he was offered signposting to peer support and to psychological services should his anxiety persist. This attention to the psychological influencing factor illustrates the holistic intent of the RLT model: a clinically sound plan that ignored David’s emotional state would have been far less likely to succeed.
Evaluation is the stage at which the ADPIE cycle turns back on itself, and it was conducted against the specific goals set during planning. At the two-week review, David was able to describe in his own words how to recognise high and low blood glucose and when to seek help, indicating that the short-term knowledge goal had been met. By the four-week review he had attended the structured education programme, replaced sugary drinks during shifts and begun preparing packed meals on most working days; he also reported a subjective reduction in anxiety and had identified a peer support group as an ongoing resource. The walking goal was partially met, as shift patterns had limited him to walking on two or three days rather than four, so this goal was retained and renegotiated into smaller, shift-specific steps rather than recorded as a failure.
Evaluating partially met goals in this constructive way is an important feature of good practice. The dependence-independence continuum provides a useful vocabulary here: David had moved towards greater independence in communicating and eating and drinking, while mobilising remained an area needing continued support. The longer-term glycaemic goal could not yet be judged, since HbA1c reflects glucose over a period of weeks to months; arrangements were therefore made for repeat testing and for the annual review of feet, eyes and kidneys, ensuring that the potential problems identified at diagnosis would be actively monitored. Throughout, documentation was maintained accurately and contemporaneously in line with professional record-keeping standards (NMC, 2018).
Several recommendations follow from this episode of care. First, continuity should be maintained so that David works with a consistent practitioner wherever possible, since the therapeutic relationship was central to his engagement. Second, the care plan should remain a living document, reviewed at each contact and adjusted as his circumstances and confidence change, rather than being treated as fixed. Third, the multidisciplinary team, including the GP, dietitian, practice nurse and, where appropriate, pharmacist, should be used to provide coordinated support, particularly if pharmacological treatment is intensified and the risk of hypoglycaemia rises. Fourth, proactive surveillance for complications should continue through the annual review structure, reflecting the potential problems identified at the outset. Finally, David’s psychological wellbeing should be reviewed at intervals, since the emotional burden of a long-term condition can fluctuate over time and may re-emerge even when physical indicators improve.
This model case study has demonstrated how the Roper-Logan-Tierney model and the ADPIE process can be combined to deliver structured, holistic and person-centred care for an adult with Type 2 diabetes. Organising the assessment around the activities of living, and interpreting it through the five influencing factors, allowed the care to extend well beyond blood glucose figures to encompass David’s work, relationships, emotions and circumstances. Expressing the findings as clear nursing diagnoses, negotiating SMART goals, implementing evidence-informed interventions and evaluating them honestly produced a plan that was both systematic and genuinely individual. The case also illustrates the limits of any single framework: models are tools to support clinical reasoning, not substitutes for it, and their value lies in how thoughtfully they are applied. Presented here purely as reference material for learning, the study is intended to show how theory, process and professional values come together in competent nursing practice, and should be used to support study rather than reproduced as a student’s own work.
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