Mary FitzGerald

Summary: • In this Clinical Practice Development (CPD) project we set out to identify and describe current approaches to the management and delivery of nursing care in an Australian Metropolitan Teaching Hospital.• Using a simple descriptive design, data were collected to elicit patterns of care provided by nursing teams. We sought to demonstrate patterns described by nursing teams (interviews) and actual patterns of care (observation).• As expected there was a degree of incongruence between the espoused and actual patterns of care.• Interview data revealed that most study wards had a view of nursing that emphasizes meeting the total care needs of patients and their families through offering biopsychosocial and educative care. The observational data revealed that a relatively large proportion of time was expended on activities that were not regarded as important by staff when interviewed (e.g. documentation) while relatively small amounts of time were observed to be spent educating patients or communicating with relatives of patients.• The identification of this type of gap creates a dissonance in clinicians that can be used to stimulate change through CPD.• Clinicians used the information to stimulate discussion and to rewrite team value statements.

This paper concentrates on the specific impact that living in rural Australia has on the experience of chronic illness, and draws on data collected in a larger phenomenological study. Eighteen rural Australians in New South Wales described their experiences and referred particularly to issues that related to their rural context. A secondary analysis of the data revealed three sub‐themes related to the concept of rural, choice of doctor, travelling and life style. The shortfalls in service identified by these participants deserves further investigation and could become fertile ground for an expanded nursing service.