Type: Case Study | Subject: Nursing | Level: Undergraduate | Word Count: ~2500 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 writing specialists.
You have been asked to prepare a nursing case study demonstrating individualised care planning for a patient newly diagnosed with type 2 diabetes. Use a recognised nursing model to structure your holistic assessment and the nursing process to structure your care plan, applying relevant NICE guidance and NMC professional standards throughout.
This case study presents an individualised care-planning example for a patient newly diagnosed with type 2 diabetes mellitus (T2DM), managed by a community nursing team following referral from primary care. Type 2 diabetes affects an estimated 4.3 million people in the UK, with prevalence continuing to rise alongside obesity rates (Diabetes UK, 2023), and nurses working in primary and community settings play a central role in supporting patients who are newly diagnosed to build the knowledge, skills and confidence required for effective self-management. Nursing input at the point of diagnosis is widely regarded as a critical window: patients’ early experiences of care, and the extent to which initial goals feel achievable rather than overwhelming, shape engagement with self-management for years afterwards (NICE, 2022).
This case applies the Roper-Logan-Tierney (RLT) Model of Nursing, based on the twelve Activities of Living, to structure a holistic nursing assessment (Roper, Logan and Tierney, 2000), and the nursing process framework, assessment, diagnosis, planning, implementation and evaluation, to structure the resulting individualised care plan. Both frameworks are widely used in pre-registration nurse education in the UK and are compatible with the person-centred, partnership-based approach to care required by the Nursing and Midwifery Council (NMC, 2018) Code. Applying two frameworks together in this way reflects standard practice in undergraduate nursing case studies: the RLT Model provides the holistic assessment lens, while the nursing process provides the structured planning cycle through which that assessment is translated into actionable, evaluable care.
As with other cases in this series, the patient described, Mrs Grace Okafor, and the practice setting, Hollybank Medical Centre, are fictional constructs created for academic illustration and do not describe a real person or organisation.
Mrs Grace Okafor is a 58-year-old woman who attended Hollybank Medical Centre, a fictional GP surgery in the West Midlands, having experienced several weeks of increased thirst, frequent urination and unusual tiredness. A fasting blood glucose test and subsequent HbA1c result of 68 mmol/mol confirmed a diagnosis of type 2 diabetes, consistent with NICE (2022) diagnostic thresholds for the condition. Mrs Okafor works part-time as a school administrator, is married, and lives with her husband; her two adult children live independently nearby. Her body mass index (BMI) is recorded at 31 kg/m², placing her in the obese range, and her family history includes a mother who developed type 2 diabetes in her sixties, a recognised risk factor (Diabetes UK, 2023). Blood pressure and cholesterol were within acceptable ranges at initial assessment, and Mrs Okafor is a non-smoker with low alcohol intake.
Mrs Okafor reports a diet that includes frequent convenience food due to limited time between work and caring responsibilities, and describes herself as “not really a gym person,” with most of her physical activity limited to walking to and from the school where she works, roughly ten minutes each way. She has no prior diagnosis of pre-diabetes or other significant medical history, and this is her first experience of a long-term condition requiring ongoing self-management.
Mrs Okafor’s mother died eight months before this consultation, following a period of declining health that Mrs Okafor describes as difficult to watch. She discloses during the nursing assessment that she has been eating more than usual since the bereavement, describing food as “one of the only things that still feels normal at the minute.” She reports feeling overwhelmed by the diabetes diagnosis on top of ongoing grief, stating that she does not know where to begin with the changes she has been told she needs to make, and expresses specific concern about needing to take medication “for the rest of my life,” a concern common among newly diagnosed patients (Funnell and Anderson, 2004).
Mrs Okafor was referred by her GP to the practice’s nurse-led diabetes clinic for structured assessment and initiation of a care plan, with a provisional plan agreed at the GP consultation to commence metformin alongside lifestyle changes, pending the nursing assessment and care-planning discussion described in this case. This assessment therefore takes place at a genuinely early and formative stage of Mrs Okafor’s diabetes journey, before firm habits, positive or negative, around self-management have been established.
Two complementary frameworks structure this analysis: the Roper-Logan-Tierney (RLT) Model, applied to assess Mrs Okafor holistically across the Activities of Living most relevant to her presentation, and the nursing process, applied to translate that assessment into a structured, evaluable care plan. The RLT Model was selected in preference to alternative nursing models such as Orem’s (2001) self-care deficit theory because, while Orem’s framework is well suited to patients with an established self-care deficit requiring compensatory nursing input, Mrs Okafor is newly diagnosed and largely capable of self-care once adequately informed and supported; the RLT Model’s broader focus on the full range of Activities of Living better captures the holistic, cross-cutting nature of her presenting circumstances, including the bereavement context, without prematurely framing her as dependent on nursing compensation for tasks she is likely able to manage herself with appropriate education.
Applying the RLT Model (Roper, Logan and Tierney, 2000), several Activities of Living are directly relevant to Mrs Okafor’s presentation. Eating and drinking is the most immediately affected activity: her reliance on convenience food, and increased comfort eating since bereavement, represent both a contributing factor to her diagnosis and a clear target for intervention, and her HbA1c result indicates that this dietary pattern has already had a measurable physiological effect. Mobilising is also relevant, given her low baseline activity level, a modifiable risk factor for glycaemic control that operates independently of diet (Diabetes UK, 2023); her current routine of two short walks daily provides a realistic existing foundation to build on rather than an entirely new behaviour to introduce. Working and playing is affected by the practical time pressures of her job and caring role, which she identifies directly as a barrier to both meal preparation and structured exercise. Maintaining a safe environment is relevant over a longer time horizon, given the elevated risk of diabetic complications, including retinopathy, neuropathy and diabetic foot problems, if glycaemic control is not established; this activity of living points towards the need for annual retinopathy screening and regular foot checks to be built into her ongoing care pathway from the outset, even though no complications are yet clinically apparent. Finally, communicating captures Mrs Okafor’s emotional response to diagnosis, her sense of overwhelm, uncertainty about the long-term implications of taking medication, and grief-related distress, all of which will directly affect her engagement with any care plan if not addressed explicitly rather than treated as background context.
Applying the nursing process (assessment, diagnosis, planning, implementation, evaluation) translates this holistic picture into an actionable plan. At the assessment stage, in addition to the clinical data recorded (HbA1c 68 mmol/mol, BMI 31 kg/m², blood pressure and cholesterol within range), the psychosocial assessment above identifies recent bereavement, comfort eating, low baseline activity and low confidence in self-management as the key modifiable factors relevant to planning. At the diagnosis stage, this analysis supports a nursing diagnosis of “ineffective health management related to new diagnosis of type 2 diabetes and recent bereavement, as evidenced by elevated HbA1c, low physical activity and reported feelings of overwhelm,” drawing on the North American Nursing Diagnosis Association (NANDA) framework commonly applied alongside the nursing process in UK pre-registration nurse education. This diagnosis directs planning towards goals that are achievable given Mrs Okafor’s current emotional state, rather than towards an idealised set of lifestyle changes she is unlikely to sustain while also processing grief.
At the planning stage, SMART goals were agreed collaboratively with Mrs Okafor rather than prescribed by the nurse, consistent with the person-centred, partnership-based approach required by the NMC (2018) Code: to attend a structured diabetes education programme within six weeks of diagnosis; to reduce processed food intake by making one specific, achievable dietary substitution each week, rather than attempting a full diet overhaul immediately; and to increase daily walking from twenty to thirty minutes over the following month, building on her existing routine rather than introducing an unfamiliar form of exercise. At the implementation stage, these goals were supported through referral to the DESMOND structured education programme (Skinner et al., 2020), referral to the practice dietitian, initiation of metformin with clear explanation of its mechanism, that it reduces hepatic glucose production and improves insulin sensitivity, and of common early side effects such as gastrointestinal upset, to directly address Mrs Okafor’s stated anxiety about long-term medication, together with a signposting conversation about local bereavement support, recognising that unaddressed grief is likely to undermine any lifestyle intervention regardless of how well it is otherwise designed. A home blood-glucose monitor was also issued with instruction on use and target ranges, giving Mrs Okafor a concrete, visible marker of progress between clinic appointments. At the evaluation stage, a follow-up appointment was scheduled at six weeks to review engagement with the education programme and self-monitoring readings, and at three months to review HbA1c, with evaluation criteria agreed in advance so that both Mrs Okafor and the nursing team share a common, measurable basis for assessing progress rather than relying on subjective impressions of how things are going.
Several issues emerge from this analysis that require particular attention in Mrs Okafor’s ongoing care. First, readiness to change: applying Prochaska and DiClemente’s (1983) transtheoretical model alongside the RLT assessment, Mrs Okafor appears to sit at the contemplation-to-preparation stage, aware of the need to change but not yet confident in how to do so, which supports the decision to set incremental rather than immediate, comprehensive goals; setting goals appropriate to her actual readiness, rather than to a generic “ideal” self-management plan, is likely to be more predictive of sustained engagement than the clinical severity of her HbA1c result alone.
Second, the interaction between bereavement and diabetes self-management is a significant risk to engagement that must not be treated as incidental. Comfort eating linked to grief is a recognised barrier to dietary change (Trikkalinou, Papazafiropoulou and Melidonis, 2017), and addressing diabetes management in isolation from this emotional context risks setting goals Mrs Okafor is unable to sustain, with a consequent risk of disengagement and self-blame if early goals are not met, potentially compounding rather than relieving her current emotional burden.
Third, health literacy and confidence: Mrs Okafor’s comment that she does not know where to begin suggests limited prior exposure to diabetes self-management information, indicating a need for information to be delivered in accessible, staged form over successive appointments rather than as a single comprehensive briefing at the point of diagnosis, consistent with NICE (2022) recommendations on structured education for newly diagnosed patients.
Fourth, longer-term complication risk: while not yet clinically apparent, Mrs Okafor’s risk of microvascular and macrovascular complications, including retinopathy, nephropathy, neuropathy and cardiovascular disease, will depend substantially on the glycaemic control achieved over the coming months and years (NICE, 2022). This means the psychosocial and behavioural issues identified above are not peripheral concerns to be addressed once “the real clinical work” is done, but are directly material to long-term physical health outcomes and should be resourced accordingly within the care plan.
Fifth, professional and ethical considerations under the NMC (2018) Code are relevant throughout this case. Mrs Okafor’s autonomy and right to be involved in decisions about her own care support the collaborative goal-setting approach taken rather than a prescriptive one, and safeguarding her dignity when discussing sensitive topics, bereavement, weight, and lifestyle habits, requires a non-judgemental, person-centred communication style rather than a purely instructional approach to advice-giving, particularly given her disclosed vulnerability around comfort eating and grief.
Building on the issues identified, five recommendations are proposed for Mrs Okafor’s ongoing care.
First, maintain incremental, collaboratively agreed goals rather than prescribing a comprehensive lifestyle overhaul at once, explicitly reviewing and building on these goals at each follow-up appointment as her confidence and readiness to change increase, consistent with Prochaska and DiClemente’s (1983) staged model.
Second, ensure bereavement is addressed alongside diabetes management, not treated as a separate issue for a different service, through continued signposting to local bereavement support and sensitive follow-up questioning at future appointments about her emotional wellbeing, not solely her clinical markers, recognising the documented link between grief, comfort eating and glycaemic control.
Third, use the structured DESMOND education programme and dietitian referral as the primary vehicles for building health literacy and practical dietary skills, supplemented by written material Mrs Okafor can revisit at her own pace between appointments, rather than relying solely on verbal advice delivered during time-limited consultations, in line with NICE (2022) guidance on structured education.
Fourth, involve Mrs Okafor’s husband in future appointments where she consents to this, given that household food preparation and routines are likely to be shared between them, and family involvement is associated with improved dietary adherence in type 2 diabetes management (Diabetes UK, 2023).
Fifth, schedule structured follow-up at six weeks and three months with evaluation criteria agreed in advance, HbA1c, self-monitoring readings, activity levels and engagement with the education programme, so that progress is assessed against Mrs Okafor’s own agreed goals rather than generic targets, and the care plan is adjusted collaboratively with her if particular goals prove unrealistic in practice.
This case study has demonstrated the application of the Roper-Logan-Tierney Model and the nursing process to structure an individualised care plan for a patient newly diagnosed with type 2 diabetes. The analysis highlights that Mrs Okafor’s diabetes cannot be effectively managed in isolation from her broader circumstances, particularly her recent bereavement and limited prior exposure to diabetes self-management information, and that a collaborative, incrementally staged approach to goal-setting is more likely to support sustained engagement than a comprehensive lifestyle prescription delivered at the point of diagnosis. The recommendations proposed integrate clinical, educational and psychosocial support, reflecting the holistic, person-centred approach embedded in both the RLT Model and the NMC (2018) Code, and provide a structured basis for evaluating Mrs Okafor’s progress at future appointments. As with other cases in this series, Mrs Okafor and Hollybank Medical Centre are fictional constructs created for academic illustration and do not describe a real patient or care setting.
Need a Model Case Study Written to Your Exact Brief?
Our 350+ UK-qualified writers deliver referenced model documents from £15 per 250 words, with free plagiarism and AI-detection reports.
You May Also Like
All work is written by human writers. 100% AI free, guaranteed.
100% money back guarantee if you find plagiarism in our work.
COMPANY DETAILS
