Midwives' perceptions of being 'with woman': a phenomenological study.

BACKGROUND: Being 'with woman' is a central construct of the midwifery profession however, minimal research has been undertaken to explore the phenomenon from the perspective of midwives. The aim of this study was to describe Western Australian midwives' perceptions of the phenomenon of being 'with woman' during the intrapartum period. METHODS: Descriptive phenomenology was selected as the methodology for this study. Thirty one midwives working across a variety of care models participated in individual interviews. Giorgi's four stage phenomenological approach was employed to analyse data. RESULTS: Three themes were extracted 1) Essential to professional identity; 2) Partnership with women; and 3) Woman-Centred Practice. Midwives described the importance of being 'with woman' to the work and identification of midwifery practice. Developing a connection with the woman and providing woman-centred care inclusive of the woman's support people was highlighted. CONCLUSIONS: For the first time, we are able to offer evidence of how midwives understand and perceive the phenomenon of being 'with woman' which has theoretical and practical utility. Findings from this study provide evidence that supports expert commentary and confirms that midwives conceptualise the phenomenon of being 'with woman' as essential to the identity and practice of the profession. Some previously identified 'good midwifery practices' were revealed as practical manifestations of the phenomenon. This new knowledge facilitates clarity and provides evidence to support statements of professional identity, which is useful for the development of educational curricula as well as supporting graduate and professional midwives. The findings emphasise the importance of the development of language around this important philosophical construct which permeates midwifery practice, enhances professional agency and supports the continued emphasis of being 'with woman' with new understanding of its applied practices in a variety of care models.

"It's what midwifery is all about": Western Australian midwives' experiences of being 'with woman' during labour and birth in the known midwife model.

BACKGROUND: The phenomenon of being 'with woman' is fundamental to midwifery as it underpins its philosophy, relationships and practices. There is an identified gap in knowledge around the 'with woman' phenomenon from the perspective of midwives providing care in a variety of contexts. As such, the aim of this study was to explore the experiences of being 'with woman' during labour and birth from the perspective of midwives' working in a model where care is provided by a known midwife. METHODS: A descriptive phenomenological design was employed with ten midwives working in a 'known midwife' model who described their experiences of being 'with woman' during labour and birth. The method was informed by Husserlian philosophy which seeks to explore the same phenomenon through rich descriptions by individuals revealing commonalities of the experience. RESULTS: Five themes emerged 1) Building relationships; 2) Woman centred care; 3) Impact on the midwife; 4) Impact on the woman; and 5) Challenges in the Known Midwife model. Midwives emphasised the importance of trusting relationships while being 'with woman', confirming that this relationship extends beyond the woman - midwife relationship to include the woman's support people and family. Being 'with woman' during labour and birth in the context of the relationship facilitates woman-centred care. Being 'with woman' influences midwives, and, it is noted, the women that midwives are working with. Finally, challenges that impact being 'with woman' in the known midwife model are shared by midwives. CONCLUSIONS: Findings offer valuable insight into midwives' experiences of being 'with woman' in the context of models that provide care by a known midwife. In this model, the trusting relationship is the conduit for being 'with woman' which influences the midwife, the profession of midwifery, as well as women and their families. Descriptions of challenges to being 'with woman' provide opportunities for professional development and service review. Rich descriptions from the unique voice of midwives, provided insight into the applied practices of being 'with woman' in a known midwife model which adds important knowledge concerning a phenomenon so deeply embedded in the philosophy and practices of the profession of midwifery.

Something has shifted: Nursing students' global perspective following international clinical placements.

AIMS: To examine understandings of global health issues among nursing students following participation in an international clinical placement during their pre-registration university education. BACKGROUND: Universities use international clinical placements, especially in developing countries, to develop cultural awareness in students; however, little is known about the longer term influences on students' understandings of global nursing. DESIGN: A retrospective cross-sectional design was used, using an exploratory, descriptive qualitative approach. METHODS: Individual semi-structured interviews were conducted in 2014 with a purposive sample of 25 pre-registration nursing students from four Western Australian universities who undertook clinical placements across five countries. Data were analysed using inductive thematic analysis. RESULTS: Findings highlight that students developed new understandings around health systems including fragility of resource access, differences in clinical practice and variances in nursing roles between settings. Students also experienced challenges but were able to appreciate alternative world viewpoints. CONCLUSION: International clinical placements can develop greater awareness and help students form realistic strategies for using their nursing skills globally. Pre-placement training in cultural awareness and health system realities, along with strong supervisory support, is critical to success.

Women's experience of intrapartum transfer from a Western Australian birth centre co-located to a tertiary maternity hospital.

BACKGROUND: The aim of this Western Australian study was to describe the overall labour and birth experience of women who were transferred during the first and second stages of labour from a low risk woman-centred, midwifery-led birth centre to a co-located tertiary maternity referral hospital. METHODS: Using a descriptive phenomenological design, fifteen women were interviewed up to 8 weeks post birth (July to October, 2013) to explore their experience of the intrapartum transfer. Giorgi's method of analysis was used. RESULTS: The following themes and subthemes emerged: 1) The midwife's voice with subthemes, a) The calming effect and b) Speaking up on my behalf; 2) In the zone with subthemes, a) Hanging in there and b) Post birth rationalizing; 3) Best of both worlds with subthemes a) The feeling of relief on transfer to tertiary birth suite and b) Returning back to the comfort and familiarity of the birth centre; 4) Lost sense of self; and 5) Lost birth dream with subthemes a) Narrowing of options and b) Feeling of panic. Women found the midwife's voice guided them through the transfer experience and were appreciative of continuity of care. There was a sense of disruption to expectations and disappointment in not achieving the labour and birth they had anticipated. There was however appreciation that the referral facility was nearby and experts were close at hand. The focus of care altered from woman to fetus, making women feel diminished. Women were glad to return to the familiar birth centre after the birth with the opportunity to talk through and fully understand their labour journey which helped them contextualise the transfer as one part of the whole experience. CONCLUSIONS: Findings can inform midwives of the value of a continuity of care model within a birth centre, allowing women both familiarity and peace of mind. Maternity care providers should ensure that the woman remains the focus of care after transfer and understand the significance of effective communication to ensure women are included in all care discussions.

The silence of mental health issues within university environments: a quantitative study.

A descriptive study was used to examine the attitudes and experiences of staff and students towards mental health problems. Staff completed the "Attitude towards mental illness survey", and students who self-identified having a mental health problem completed the "Stigma scale". Using an online collection process, data from 270 staff and 201 students showed that the "silence" surrounding mental health problems permeates the university environment and impacts on help seeking behaviors, the provision of support and on the recovery and wellbeing of affected individuals. Universities must decrease stigma and foster social inclusion to build self-esteem in people who have mental health problems.

An exploration of nursing research perceptions of registered nurses engaging in research activities at a metropolitan hospital in Western Australia.

AIM: To explore perceptions about nursing research of registered nurses (RNs) who were engaged in research activities at a metropolitan hospital in Western Australia. BACKGROUND: In order to improve RNs' research engagement and promote evidence-based practice, Nurse Research Consultants (NRCs) were appointed jointly by the study hospital and a local university. This joint appointment commenced in 2004 in the hospital's emergency department. Early findings indicated that the NRC role was effective in assisting registered nurses with research activities and hence the NRC role was expanded to all areas of the hospital. However, no formal investigation had been carried out to explore the effect of the NRC role on RNs' engagement with nursing research across the hospital. DESIGN: A qualitative interview process. METHODS: Ten RN participants from the adult and paediatric wards were interviewed. Audio-recorded data were transcribed verbatim and thematic analysis was undertaken. RESULTS: Four main themes were identified, namely: perceptions of nursing research, perceived enablers, perceived barriers and improving research engagement. There was some overlap with some sub-themes being linked with more than one theme. This appeared to be due to differing levels of research education and research engagement. CONCLUSION: 6pc some of the RNs that participated in this study were experienced in the conduct of research, finding adequate support from NRCs in the workplace, whilst others experienced barriers limiting their involvement in nursing research activities. These barriers could be reduced with additional education, support, improved communication, time and opportunities to undertake research activities.

Preparing Students for Post-COVID Nursing Careers: The Value of International Clinical Placements.

BACKGROUND: Prior to the coronavirus disease 2019 (COVID-19) pandemic, international clinical placements (ICPs) for nursing students were used to build cultural humility and global awareness. This study explored the influence of ICPs on nursing students' career planning and views of the nursing role; the findings were considered against the evolving pandemic context. METHOD: A qualitative, descriptive longitudinal study was conducted with 25 preregistration nursing students who participated in an international placement. Semistructured individual interview data were examined using thematic analysis. RESULTS: Participants were interested in patient equity and empowerment, high acuity and variety, health policy, and primary care. Participants developed resilience and nursing confidence. They saw the effects of poor health equity and health policy decisions on population health. CONCLUSION: ICPs expanded participants' understanding of global interconnectedness and also identified new career possibilities. Postpandemic, nursing education should continue to maintain a global focus on health. [J Nurs Educ. 2023;62(4):207-214.].

Coping with COVID-19. Work life experiences of nursing, midwifery and paramedic academics: An international interview study.

BACKGROUND: The COVID-19 global pandemic was declared in March 2020. By June 2022, the total deaths worldwide attributed to COVID-19 numbered over 6.3 million. Health professionals have been significantly impacted worldwide primarily those working on the frontline but also those working in other areas including nursing, midwifery, and paramedic higher education. Studies of occupational stress have focused on the clinical health professional roles but scant attention has been drawn to the pressures on university-based academic staff supporting and preparing professionals for frontline health work. DESIGN AND OBJECTIVES: This qualitative study sought to explore the challenges experienced by health academics (nurses, midwives and paramedics), during COVID-19 and identify strategies enlisted. SETTING AND PARTICIPANTS: Six Australian and two United Kingdom universities collaborated, from which 34 health academics were individually interviewed via video or teleconference, using six broad questions. Ethical approval was obtained from the lead site and each participating University. DATA ANALYSIS: Thematic analysis of the data was employed collaboratively across institutions, using Braun and Clarke's method. RESULTS: Data analysis generated four major themes describing academics': Experiences of change; perceptions of organisational responses; professional and personal impacts; and strategies to support wellbeing. Stress, anxiety and uncertainty of working from home and teaching in a different way were reported. Strategies included setting workday routine, establishing physical boundaries for home-working and regular online contact with colleagues. CONCLUSIONS: The ability of nursing, midwifery and, paramedic academic staff to adapt to a sudden increase in workload, change in teaching practices and technology, while being removed from their work environment, and collegial, academic and technological supports is highlighted. It was recognised that these changes will continue post-COVID and that the way academics deliver education is forever altered.

Midwives' experiences of learning and teaching being 'with woman': A descriptive phenomenological study.

Being 'with woman' is a fundamental concept of midwifery philosophy. Minimal evidence explicates ways this important construct is learned or taught. This paper reflects one part of a larger study and explored midwives' experiences of learning and teaching related to the phenomenon of being 'with woman'. Using a descriptive phenomenological approach, 31 midwives working in a variety of models in Western Australia were interviewed to explore the phenomenon of being 'with woman'. Rich descriptions of how midwives learned and taught others to be 'with woman' were obtained. Descriptive phenomenology is useful in revealing features of the phenomenon through description of lived experiences of purposively sampled participants. Giorgi's method was used to analyse data from the two main interview questions. The themes for learning to be 'with woman' were observing midwives; inspirational leaders; learning from the women; a variety of experiences enhances learning; and, develops over time. The themes for teaching being 'with woman' were, approaches for teaching; teaching is implicit; reliance on observation, comprehension and assimilation. Insights into the learning and teaching of practices supported by professional philosophy offer educators and leaders new knowledge and ways to enhance the transfer of knowledge and skills of being 'with woman'.

Midwifery students': Developing an understanding of being 'with woman'--A qualitative study.

OBJECTIVES: To explore and describe what student midwives, enrolled in one Western Australian (WA) university, had witnessed, learned and experienced regarding the concept of being 'with woman'. DESIGN: A qualitative descriptive design was chosen. SETTING: A university in Perth, Western Australia. PARTICIPANTS: Nineteen student midwives from an undergraduate and a post graduate midwifery course. METHODS: Data were collected from audio-recorded interviews. Thematic analysis of interview transcripts was used to identify commonalities of perceptions and experiences of being 'with woman' for students. Data saturation guided when recruitment ceased and final sample size was achieved. FINDINGS: Student interviews revealed that when considering the concept of being 'with woman' students were able to give descriptors of what they interpreted the meaning of being 'with woman' to be. They also described factors that impacted their learning of how to be 'with woman'. Included in their descriptors were that being 'with woman' enables informed choice, it creates a connection, it means the woman is at the centre of care and that it can occur in all contexts. The factors that impacted their learning of how to be 'with woman' were the importance of positive midwife role models, that providing continuity of care models accelerate learning, that the student role and workload can impact their perceived ability to be with woman and that they are aware it takes time to learn how to be 'with woman'. CONCLUSION AND IMPLICATIONS: The art and skills of being 'with woman' are central to midwifery practice; students in this study were able to demonstrate understanding of the concept and also highlight factors that influence their learning of how to be 'with woman'. Findings can inform how the phenomenon of being 'with woman' can be intentionally introduced into midwifery programs, with particular emphasis on positive midwifery role models, realistic student workload and recognition of the value of the Continuity of Care Experience.

Midwives 'with woman' in the private obstetric model: Where divergent philosophies meet.

BACKGROUND: The phenomenon of being 'with woman' is central to the profession of midwifery. There is currently no available evidence that explicitly explores this phenomenon. In Western Australia, over a third of childbearing women choose to engage the services of a private obstetrician who provides antenatal care and manages the care provided by midwives during labour and birth. AIM: The aim of this study was to explore midwives' experiences of being 'with woman' during labour and birth in the private obstetric model. METHODS: Using a descriptive phenomenological approach, 11 midwives working in the private obstetric model in Western Australia were interviewed. Data analysis was conducted using Giorgi's framework. FINDINGS: Two main themes emerged (1) triad of relationships and (2) the intersection between being 'with woman' and the private obstetric model; seven subthemes are reported. DISCUSSION: Being 'with woman' is an important element of midwifery practice and fundamental to midwifery theory and philosophy. Relationships between the woman, midwife and obstetrician are key to implementing 'with woman' practices in the private obstetric model. The interrelatedness of midwifery philosophy and practice is revealed through shared common challenges and enablers to being 'with woman' from the perspective of midwives. CONCLUSION: Findings offer insight into midwives' experiences of being 'with woman' within the context of the private obstetric model. New understandings are revealed of a phenomenon central to midwifery professional philosophy that is embedded within midwifery practices which has implications for service mangers, professional leaders and educators.

One Year On: Cultural Competence of Australian Nursing Students Following International Service-Learning.

BACKGROUND: The effective delivery of health care to the growing multicultural population within Australia is a challenge for the nursing profession. A breakdown in cross-cultural communication and understanding, which stems from the tendency of nurses to project their own culturally specific values and behaviors onto patients and colleagues from other countries, can contribute significantly to non-compliance in migrant populations and conflict in collegial relationships. METHOD: The Inventory for Assessing the Process of Cultural Competence-Revised was administered to Australian undergraduate nursing students immediately before, immediately after, and 12 months after returning from international clinical placement. Data were analyzed using descriptive and inferential functions of SPSS. RESULTS: Overall cultural competence increased immediately following the placement and was sustained over time. However, there were significant differences among the five constructs measured. CONCLUSION: International clinical placements enhance cultural competence but targeted activities need to be undertaken pre-placement to develop specific aspects, in particular cultural desire. [J Nurs Educ. 2019;58(1):17-26.].

Urgency to build a connection: Midwives' experiences of being 'with woman' in a model where midwives are unknown.

OBJECTIVE: The objective of this study was to explore midwives' experiences of being 'with woman' in the intrapartum period within the context of an unknown midwife model. DESIGN: A descriptive phenomenological design was used with individual in-depth interviews. Transcribed interviews were analysed using thematic analysis that incorporated the data analysis framework offered by Amadeus Giorgi. SETTING: Hospitals within Western Australia providing intrapartum care to women where the midwife is not usually known to them. PARTICIPANTS: Ten midwives were interviewed and recruitment ceased when data saturation was reached. FINDINGS: Findings confirm the importance of building a connection to enable partnership with the woman and provide woman-centred care that is inclusive of her partner. Factors influencing midwives' ability to be 'with woman' included the 'systems' approach to childbearing as well as common birth interventions prevalent within the public hospital system. Midwives experienced both rewards and challenges associated with being 'with woman' in the unknown midwife model, adaptability and self-awareness were features that enhanced the ability to be 'with woman' within this model. KEY CONCLUSIONS: Findings present new knowledge about being 'with woman', a phenomenon so central to the profession of midwifery, yet previously unexplored in the empirical domain. Insights gained reveal the intersection between the phenomenon and the unknown midwife model and highlight characteristics of the midwives that facilitate being 'with woman' such as adaptive expertise. IMPLICATIONS FOR PRACTICE: Understanding the concept of being 'with woman' through the lived experience of midwives provides unique insight into the applied practices of the phenomenon. Characteristics of being 'with woman' as well as attributes and strengths demonstrated by the midwives provides important data for education and development of the profession. Explicating the challenges faced by midwives seeking to be 'with woman' in the unknown midwife model is useful for health leaders of service delivery and policy development to consider innovative ways to enhance this important practice advised by professional philosophy.

Midwives being 'with woman': An integrative review.

BACKGROUND: Midwives being 'with woman' is embedded in professional philosophy, standards of practice and partnerships with women. In light of the centrality of being 'with woman' to the profession of midwifery, it is timely to review the literature to gain a contemporary understanding of this phenomenon. AIM: This review synthesises research and theoretical literature to report on what is known and published about being 'with woman'. METHODS: A five step framework for conducting an integrative literature reviews was employed. A comprehensive search strategy was utilised that incorporated exploration in electronic databases CINAHL, Scopus, Proquest, Science Direct and Pubmed. The initial search resulted in the retrieval of 2057 publications which were reduced to 32 through a systematic process. FINDINGS: The outcome of the review revealed three global themes and corresponding subthemes that encompassed 'with woman': (1) philosophy, incorporated two subthemes relating to midwifery philosophy and philosophy and models of care; (2) relationship, that included the relationship with women and the relationship with partners; and (3) practice, that captured midwifery presence, care across the childbirth continuum and practice that empowers women. CONCLUSION: Research and theoretical sources support the concept that being 'with woman' is a fundamental construct of midwifery practice as evident within the profession's philosophy. Findings suggest that the concept of midwives being 'with woman' is a dynamic and developing construct. The philosophy of being 'with woman' acts as an anchoring force to guide, inform and identify midwifery practice in the context of the rapidly changing modern maternity care landscapes. Gaps in knowledge and recommendations for further research are made.

An exploration of Indonesian nurses' perceptions of barriers to paediatric pain management.

There is a dearth of research in Indonesia regarding pain management in children. Previous studies have identified that although a variety of research and clinical studies on all aspects of pain have been conducted in many countries, children continue to experience moderate to severe pain during hospitalization. Greater research efforts are needed to identify and explore the factors that impede effective pain management in children. To address this gap, the researchers conducted an exploratory descriptive qualitative study to capture Indonesian nurses' perceptions of barriers to paediatric pain management in two hospitals. Using purposive sampling, data were collected from 37 nurses through semi-structured, in-depth interviews. Findings indicated that nurses working in Indonesian paediatric wards felt that they were not able to provide effective pain care to hospitalized children. Nurses identified several organizational structural and cultural factors that were thought to hinder their provision of effective pain care to paediatric patients. These factors are embedded in nurses' clinical practice. The study findings can assist to inform relevant initiatives and strategies to improve clinical nurses' performance and competency in providing effective pain care to paediatric patients.

The woman, partner and midwife: An integration of three perspectives of labour when intrapartum transfer from a birth centre to a tertiary obstetric unit occurs.

BACKGROUND: When transfer in labour takes place from a birth centre to a tertiary maternity hospital the woman, her partner and the midwife (the triad) are involved, representing three different perspectives. The purpose of this paper is to explore the integration of these intrapartum transfer experiences for the birth triad. METHODS: Giorgi's descriptive phenomenological method of analysis was used to explore the 'lived' experiences of Western Australian women, their partners and midwives across the birth journey. Forty-five interviews were conducted. FINDINGS: Findings revealed that experiences of intrapartum transfer were unique to each member of the triad (woman, partner and midwife) and yet there were also shared experiences. All three had three themes in common: 'The same journey through three different lenses'; 'In my own world' and 'Talking about the birth'. The woman and partner shared two themes: 'Lost birth dream' and 'Grateful to return to a familiar environment'. The woman and midwife both had: 'Gratitude for continuity of care model' and the partner and midwife both found they were: 'Struggling to adapt to a changing care model' and their 'Inside knowledge was not appreciated'. CONCLUSION: Insight into the unique integrated experiences during a birth centre intrapartum transfer can inform midwives, empowering them to better support parents through antenatal education before and by offering discussion about the birth and transfer after. Translation of findings to practice also reinforces how midwives can support their colleagues by recognising the accompanying midwife's role and knowledge of the woman.

Midwives' experiences of transfer in labour from a Western Australian birth centre to a tertiary maternity hospital.

BACKGROUND: When transfer in labour takes place from a woman-centred, midwifery led centre to a tertiary maternity hospital it is accepted that women are negatively affected, however the midwife's role is unevaluated, there is no published literature exploring their experience. This study aimed to describe these experiences. METHODS: Giorgi's descriptive phenomenological method of analysis was used to explore the 'lived' experiences of the midwives. Seventeen interviews of transferring midwives took place and data saturation was achieved. FINDINGS: The overall findings suggest that midwives find transfer in labour challenging, both emotionally and practically. Five main themes emerged: (1) 'The midwife's internal conversation' with subtheme: 'Feeling under pressure', (2) 'Challenged to find a role in changing circumstances' with subtheme: 'Varying degrees of support', (3) 'Feeling out of place' with subtheme: 'Caught in the middle of different models of care, (4) 'A constant support for the parents across the labour and birth process' with subthemes: 'Acknowledging the parents' loss of their desired birth' and (5) 'The midwives' need for debrief'. CONCLUSION: Midwives acknowledged the challenge of finding the balance between fulfilling parents' birth plan wishes with hospital protocol and maintaining safety. Transfer for fetal or maternal compromise caused anxiety and concern. The benefits of providing continuity of care were acknowledged by the midwife's knowledge of the woman and her history but these were not always recognised by the receiving team. Discussing the transfer story afterwards helped midwives review their practice. Effective communication between all stakeholders is essential throughout the transfer process.

Motivations and Expectations of Undergraduate Nursing Students Undertaking International Clinical Placements.

BACKGROUND: International clinical placements are common in preregistration nursing programs in Australian universities to enhance awareness of cultural needs and global health issues. Yet, little is known about the motivations and expectations of nursing students who choose to participate. METHOD: Using a qualitative exploratory design, individual semistructured interviews were undertaken with 52 preregistration final-year nursing students from four Western Australian universities 2 weeks prior to departure to the developing countries of Tanzania, Thailand, the Philippines, Cambodia, and India. Data were analyzed using thematic analysis. RESULTS: The interviews revealed that students were motivated by cultural inquisitiveness and a desire to help. They expected to gain cultural learning, to be challenged, to be fulfilled, to experience professional growth, and to feel gratitude. Developing an understanding of culture was a crucial outcome. CONCLUSION: By understanding the impetus and personal motivations of students, educators can guide students toward a more transformative experience whereby a more multicultural perspective on health care can be developed. [J Nurs Educ. 2016;55(9):487-494.].

Australian nursing and midwifery educators delivering evidence-based education in Tanzania: A qualitative study.

Since 2011, Western Australian nursing and midwifery educators have been providing evidence-based continuing education to Tanzanian health professionals. Despite thorough preparation before departure, differences in local resource levels and available facilities have necessitated impromptu adaptation of curriculum content and delivery methods to ensure an effective program was delivered. This study explored the personal, cultural and teaching strategies utilised by Western Australian nursing and midwifery educators in Tanzania and examined if the transferability of education packages was influenced by the educators' cultural competence. Using a qualitative exploratory approach, data was collected from 15 Western Australian nursing and midwifery educators using a demographic survey and in-depth individual semi-structured interviews. The core themes identified from the analysis were Determination to learn, Assessing needs, Communication skills and Greater understanding. These findings are described using the conceptual framework of Campinha-Bacote's The Process of Cultural Competence in the Delivery of Healthcare Services. With appropriate levels of cultural competence, international health professionals can be effective at providing ongoing professional development to colleagues in developing country contexts, which may help address difficulties with retention and motivation of staff. It is essential that prior to departure cultural competence training is provided to educators to enhance their teaching capacity and effectiveness in international settings.

Client satisfaction as a driver of quality improvement in services for older people: a Western Australian case study.

This paper aims to describe a practical example of the use of adapted versions of a resident satisfaction questionnaire for quality improvement purposes in a large aged care service organisation. Residential care and home care questionnaires each covered 11 aspects, the 'housing' questionnaire nine. Each aspect included Likert scale-type satisfaction questions. Questionnaires were distributed for completion by residents or by a friend/family member where a resident was unable to self-complete (e.g. because of dementia). Over the six separate customer satisfaction surveys conducted by the organisation since 1999, the analysis scheme has been refined and forms the basis of a report to the Board highlighting major findings and making recommendations regarding future actions. Most recently, the Board has decided to focus on three main areas, with actions identified for each, namely satisfaction with staff (e.g. enhanced staff training), social activities and involvement (e.g. increased occupational therapy), and opportunities for enhanced feedback.