This thesis explores the contrasting experience of the discharge of older people from hospital on a Care of the Elderly Unit and Medical/Surgical Unit in a District General Hospital in North Wales. It comprises both the results of a Fourth Generation evaluation (Guba and Lincoln, 1989) and the later development of a substantive grounded theory of the discharge process (Charmaz, 2000). Both elements of the thesis were informed by a constructivist approach to research and the presentation and style of the thesis reflects this orientation. Data were collected from all the main stakeholder groups (members of the multidisciplinary team, patients and carers, members of the primary health care team) using a variety of methods including semi-structured interviews, documentary analysis and periods of observation. These data were then fed into a series of hermeneutic cycles in an effort to reach consensus about desired change. Barriers to both consensus and change were identified and explored largely in terms of the threat they posed to traditional medical power bases. The subsequent theory suggested that the differences between the Units could be explained largely in terms of the orientations on the ward, one of which 'processed patients' with an emphasis on pace (speed of throughput) while the other 'processed people' with more recognition of the complex needs of older individuals. In both Units the role of the nurse was significant and comprised a number of key processes: pushing; fixing; informing and brokering. The ways in which these processes interact are considered and their impact on the discharge process described. 5 The quality of the thesis is considered on a number of criteria and the extent to which the results can be recontextualised is addressed. Finally, implications for policy and practice in the light of recent developments are discussed.