Guba and Lincoln's (1989) four generations of evaluation give the framework for this study. The first three generations of nursing evaluation are categorized as 'measurement-oriented', 'objective-oriented' and 'judgement-oriented' and I present fourth generation evaluation as 'negotiation-oriented', which argues for all stakeholders, including patients, to have a right to place their issues, concerns and claims on the negotiating table. The focus of this study is the location of patients' voices as a preliminary step towards fourth generation evaluation. The phenomenological and hermeneutic ideas of the philosophers Husserl and Heidegger are explored and compared, to show the way in which nurses have used these ideas to guide research. The aim of this exploration is to develop an interpretive methodology for listening to patients' voices. Gadamer's philosophical hermeneutics guide this study. Three issues concerning legitimation of the hermeneutic research process are addressed: the philosophical underpinning of the methodology, the participation of the researcher in making the data, and the way in which trustworthiness of hermeneutic research can be established. The aim of the study is to express the concerns of older patients who were admitted to the acute care sector. The study took place in two Care of the Elderly wards in a 1000 bed NHS hospital in the United Kingdom. Fourteen patients were interviewed, each on several occasions and their concerns are expressed in themes, namely: Routine Geriatric Style of Care (from Baker 1978), depersonalisation, care deprivation and geriatric segregation. A construction is developed to incorporate these major themes. Inhumane experiences are shown to be shaped by the history and the culture of geriatric wards. Resistance to change within health care institutions is highlighted. Ageism plays a large role in depersonalisation and care deprivation of patients. The stereotyping of older persons profoundly affects the way they are perceived and consequently treated. The emerging construction calls for changes in thinking about nursing practice, a review of the 'Routine Geriatric Style' of care, a review of segregation based on age and a critical social gerontology programme for nurse education. Health care decision makers need to question whose interests are served by evaluation based on measurement. I propose that the negotiation-orientation of fourth generation evaluation has much to offer all stakeholders, particularly clients/patients, in the health care system.