Compromise, massive encouragement and forcing: a discussion of mechanisms used to limit the choices available to the older adult in hospital.

This paper gives a partial account of the findings of a qualitative research project concerning the quality of life of older people in nursing homes and hospital wards. Using strategies of ethnographic interview and hermeneutical analysis, 14 older people and 11 nurses were asked to discuss issues relating to the quality of life. Nursing staff said that older people should be treated as individuals. In practice, this meant that they should be given freedom of choice in matters concerning the conduct of their daily lives. Paradoxically, some nurses were also prepared to describe a range of tactics by which they deny older people choice in various circumstances. These tactics are (i) coming to a compromise; (ii) massive encouragement; and (iii) forcing. The ways in which the staff justify these tactics are examined and evaluated.