Nursing Assignment Example Diabetes Care Plan

Introduction

Type 2 diabetes is one of the most common long-term conditions managed across United Kingdom primary and secondary care, and nurses are central to its day-to-day management. The condition is characterised by insulin resistance and relative insulin deficiency, producing sustained hyperglycaemia that, if poorly controlled, drives microvascular and macrovascular complications such as retinopathy, nephropathy, neuropathy and cardiovascular disease (Holt et al., 2021). Because the condition is largely managed by the person themselves between clinical contacts, the registered nurse’s role extends well beyond medication administration to encompass assessment, education, risk reduction and the coordination of multidisciplinary care.

This assignment has been written as a model example to show undergraduate nursing students how a structured, evidence-based care plan is constructed for an adult with type 2 diabetes. It applies the ADPIE framework, a problem-solving approach that organises nursing care into five systematic stages, and maps each stage to current National Institute for Health and Care Excellence (NICE) guidance and the professional expectations set out in the Nursing and Midwifery Council (NMC) Code (NMC, 2018a). Throughout, the emphasis is on person-centred, holistic practice rather than on the disease in isolation. The specific objectives are to:

• demonstrate a systematic, holistic nursing assessment of an adult with type 2 diabetes;
• formulate prioritised, defensible nursing diagnoses from the assessment data;
• plan measurable, person-centred goals and evidence-based interventions; and
• evaluate care against agreed outcomes while reflecting on professional accountability.

Patient Scenario and Clinical Context

To keep the care plan self-contained and to protect confidentiality in line with the NMC Code, the patient is presented as an illustrative composite and referred to throughout as “Mr D”. A pseudonym is used and no identifying details relate to any real individual; all clinical values are fictional and are included only to demonstrate the reasoning involved (NMC, 2018a).

Mr D is a 58-year-old man who was diagnosed with type 2 diabetes four years ago. He attends a routine review at his general practice, where the practice nurse notes that his most recent glycated haemoglobin (HbA1c) result has risen to 74 mmol/mol, well above his individualised target of 53 mmol/mol. He is prescribed metformin 1 g twice daily but reports that he frequently forgets his evening dose. Mr D works long shifts as a delivery driver, describes his diet as “whatever is quickest”, and has gained weight over the past year. He lives with his wife, is a lifelong non-smoker and drinks alcohol within recommended limits. He mentions, almost in passing, that he feels “fed up with the whole thing” and worries about “ending up like his father”, who had a lower-limb amputation. This scenario provides the clinical and psychosocial context for the care plan that follows.

Assessment: Systematic Data Collection

Assessment is the foundation of safe nursing care; without accurate, holistic data collection the remaining stages of the process are compromised (Dougherty and Lister, 2015). A structured approach was used to gather both physiological and psychosocial information, combining physical measurements, review of the clinical record, and a conversation that explored Mr D’s understanding, priorities and concerns. Adopting a biopsychosocial perspective is particularly important in diabetes, where self-management behaviour, mood and social circumstances influence clinical outcomes as strongly as pharmacology (Phillips, 2020). The key findings are summarised in the assessment table below.

Interpreting these findings together, rather than in isolation, is central to good nursing judgement. Mr D presents a cluster of interacting risks: raised glycaemia, hypertension and obesity that jointly increase cardiovascular risk, early signs of neuropathy, a knowledge deficit, and emotional strain that may be undermining his self-care. NICE recommends an individualised approach in which HbA1c targets, lifestyle support and treatment are agreed with the person rather than imposed, taking account of their circumstances, preferences and risk of hypoglycaemia (NICE, 2022). The assessment therefore informs not only what needs to change, but what Mr D himself is most motivated to address.

Nursing Diagnosis

From the assessment data, several actual and potential problems can be formulated as nursing diagnoses. A nursing diagnosis identifies a human response to a health condition that falls within the nurse’s remit to address, and is distinct from the underlying medical diagnosis of type 2 diabetes (Dougherty and Lister, 2015). Prioritisation follows clinical urgency and Mr D’s own concerns, consistent with the person-centred emphasis of the NMC Code (NMC, 2018a). The prioritised diagnoses are:

1. Ineffective management of glycaemic control related to inconsistent medication adherence and dietary choices, as evidenced by an HbA1c of 74 mmol/mol and self-reported missed doses.
2. Risk of impaired skin integrity (diabetic foot ulceration) related to peripheral neuropathy and dry skin, as evidenced by reduced monofilament sensation and cracked skin.
3. Deficient knowledge regarding diabetes self-management related to not having accessed structured education, as evidenced by limited understanding of carbohydrate choices and foot care.
4. Risk of emotional distress (diabetes distress) related to the demands of the condition and fear of complications, as evidenced by low mood and expressed anxiety about amputation.

Hyperglycaemia is prioritised first because it is the driver of long-term harm and is immediately modifiable; foot risk follows closely because neuropathy, once ulceration develops, can escalate rapidly. However, the knowledge deficit and emotional distress are not secondary afterthoughts: they are the levers through which the physiological problems are realistically addressed, which is why they are planned for alongside the clinical priorities.

Planning: Goals and Expected Outcomes

Planning translates each diagnosis into a measurable, time-bound goal agreed collaboratively with Mr D. Goals are framed using the SMART principle (specific, measurable, achievable, realistic and time-bound) so that progress can be evaluated objectively (Royal College of Nursing, 2021). Crucially, the targets were negotiated rather than dictated; shared decision-making improves adherence and respects the person’s autonomy, a principle embedded in both NICE guidance and the NMC Code (NICE, 2022; NMC, 2018a). The agreed goals are:

• Short-term: Mr D will take his prescribed metformin as directed on at least six of seven days each week within two weeks, supported by an agreed reminder strategy.
• Short-term: Mr D will demonstrate correct daily foot-care technique and inspect his feet daily within one week.
• Medium-term: Mr D will attend a structured diabetes education programme within eight weeks and identify two achievable dietary changes.
• Long-term: Mr D’s HbA1c will fall towards his individualised target of 53 mmol/mol at his next review in three months, with blood pressure moving towards 140/80 mmHg.

Implementation: Evidence-Based Interventions

Implementation delivers the planned interventions, each of which is justified by current evidence and guidance. Care is coordinated across the multidisciplinary team, with the nurse frequently acting as the point of continuity and the person’s advocate (NMC, 2018b). The interventions are mapped to their corresponding diagnoses and goals in the table below.

In practice these interventions are interdependent. Addressing Mr D’s low mood and fear, for example, is likely to improve his engagement with medication and diet, while a genuine reminder strategy worked out around his shift pattern is more sustainable than generic advice to “remember your tablets”. The nurse’s role is therefore to integrate the clinical and the personal, delivering care that is technically correct and realistic for the individual’s life. Referrals to the dietitian, podiatry and the structured education programme illustrate the coordinating function of the registered nurse within the wider team.

Alongside these targeted interventions, the plan embeds Mr D within a programme of routine, structured surveillance designed to detect complications early, when they are most amenable to treatment. This includes his annual retinal screening, regular monitoring of renal function through estimated glomerular filtration rate and urinary albumin-to-creatinine ratio, review of blood pressure and lipids, and the annual foot check already described. Explaining the purpose of each of these checks is itself an intervention: when Mr D understands that screening protects his sight, kidneys and feet rather than simply adding appointments, he is more likely to attend. The nurse documents each element clearly so that the whole team can see what has been completed and what remains outstanding, reducing the risk that a routine but important check is missed between contacts (NICE, 2022).

Evaluation: Measuring Progress

Evaluation closes the cycle by judging whether the goals have been met, partially met or not met, and by using that judgement to revise the plan. It is an ongoing rather than a one-off activity (Dougherty and Lister, 2015). At a two-week telephone follow-up, Mr D reports taking his metformin on six of the past seven days using a phone alarm linked to locking his delivery van, so the first short-term goal is assessed as met. He describes inspecting his feet most days but is unsure what changes should prompt concern, so the foot-care goal is partially met and education is reinforced. He has booked a place on the next structured education course, keeping the medium-term goal on track.

Because HbA1c reflects glycaemia over the preceding two to three months, the long-term glycaemic goal cannot yet be judged and will be reassessed at the three-month review. Evaluation is explicitly collaborative: Mr D is asked what has helped and what has been difficult, and the plan is adjusted accordingly, for example by simplifying the dietary target to a single, concrete change he feels able to sustain. This responsiveness reflects the dynamic nature of the nursing process, in which assessment data continually feed back into revised diagnoses, goals and interventions rather than being treated as fixed.

Honest evaluation also means acknowledging where progress has stalled and avoiding the assumption that non-adherence reflects a lack of motivation. If Mr D had continued to miss doses, the appropriate nursing response would be to revisit the assessment, explore barriers such as side-effects, cost or competing priorities, and adjust the plan in partnership rather than simply repeating the same advice. Documenting both the outcomes achieved and the clinical reasoning behind any revision ensures continuity of care and provides an auditable record, in keeping with the professional duty to keep clear and accurate records (NMC, 2018a).

Patient Education and Health Promotion

Health promotion is woven through every stage of this care plan rather than being an isolated activity. For a condition that is largely self-managed, the nurse’s educational role is arguably the most influential contribution to long-term outcomes (Phillips, 2020). Effective education is tailored to the individual’s literacy, culture and readiness to change, and it builds confidence as well as knowledge. With Mr D, education focused on three practical priorities: understanding how carbohydrate choices affect blood glucose, recognising the early warning signs of foot problems, and knowing when and how to seek help. The teach-back method was used to confirm understanding, asking Mr D to explain each point in his own words rather than simply agreeing that he understood.

Motivational, non-judgemental communication is particularly important when behaviour change feels overwhelming. Rather than issuing a list of prohibitions, the nurse worked with Mr D to identify small, achievable changes, such as swapping sugary drinks for water during his shifts, an approach consistent with person-centred, strengths-based practice. Signposting to reputable sources, including his structured education programme and recognised national resources, extends support beyond the consultation and promotes sustainable self-efficacy (Diabetes UK, 2023).

Professional Accountability and the NMC Standards

Throughout this care plan, practice is anchored in the four themes of the NMC Code: prioritise people, practise effectively, preserve safety and promote professionalism and trust (NMC, 2018a). Prioritising Mr D meant respecting his autonomy and negotiating goals rather than imposing them. Practising effectively meant grounding each intervention in current NICE guidance and the best available evidence, and documenting care accurately so that colleagues could continue it safely. Preserving safety was reflected in the timely foot assessment and the recognition of when to escalate or refer, acknowledging the limits of the nurse’s own competence. Promoting professionalism and trust underpinned the confidential, respectful handling of a patient who felt vulnerable and “fed up”.

These expectations are reinforced by the NMC standards of proficiency for registered nurses, which require newly qualified nurses to assess need, plan and deliver evidence-based care, and work effectively within multidisciplinary teams (NMC, 2018b). The care plan also demonstrates accountability in the broader sense: the nurse is answerable not only for the tasks performed but for the clinical judgement exercised, including the decision to refer to podiatry, the dietitian and psychological support when needs exceeded the scope of a single consultation. This model is offered as a learning resource; in real practice, every assessment, diagnosis and intervention would be validated against the individual patient, local policy and the most current guidance.

Conclusion

This model assignment has demonstrated how an undergraduate nursing student can construct a systematic, evidence-based care plan for an adult with type 2 diabetes using the ADPIE framework. By moving from a holistic assessment through prioritised nursing diagnoses, negotiated SMART goals, evidence-based interventions and collaborative evaluation, it has shown that effective diabetes care depends on integrating clinical knowledge with person-centred communication. The plan has been mapped throughout to NICE guidance and the NMC Code, illustrating how professional standards translate into everyday decisions at the bedside and in the clinic. Written for learning purposes only, the example highlights the registered nurse’s distinctive contribution: not merely managing a disease, but supporting a person to live well with a lifelong condition.

References

• Barnard, K.D. (2019) ‘Psychological aspects of diabetes management’, Practical Diabetes, 36(4), pp. 129–133.
• Diabetes UK (2023) Us, diabetes and a lot of facts and stats. London: Diabetes UK.
• Dougherty, L. and Lister, S. (eds.) (2015) The Royal Marsden Manual of Clinical Nursing Procedures. 9th edn. Chichester: Wiley-Blackwell.
• Holt, R.I.G., Cockram, C.S., Flyvbjerg, A. and Goldstein, B.J. (eds.) (2021) Textbook of Diabetes. 5th edn. Oxford: Wiley-Blackwell.
• National Institute for Health and Care Excellence (2019) Diabetic foot problems: prevention and management. NICE guideline NG19. London: NICE.
• National Institute for Health and Care Excellence (2022) Type 2 diabetes in adults: management. NICE guideline NG28. London: NICE.
• Nursing and Midwifery Council (2018a) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. London: NMC.
• Nursing and Midwifery Council (2018b) Future Nurse: Standards of Proficiency for Registered Nurses. London: NMC.
• Phillips, A. (2020) ‘Optimising the person-centred management of type 2 diabetes’, Nursing Standard, 35(6), pp. 61–66.
• Royal College of Nursing (2021) Diabetes: RCN Guidance on the Nursing Management of Adults. London: RCN.
• World Health Organization (2023) Diabetes: Key Facts. Geneva: WHO.