S.TRUEMAN PhD THESIS 2016

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[What] we would most likely do is get an order for medication to make them a little more—like a chemical restraint … We’d probably use a chemical restraint overnight. [T4, p. 7] Another nurse participant stated: Initially, … we … gave him [patient] … Valium. [T3, p. 5] The best we [remote nurses] could think to do was to sedate him [mental health patient]. [T3, p. 6] This is consistent with a participant psychiatrist’s view: When it’s a real serious [psychiatric] emergency, it doesn’t require a psychiatrist— it requires someone with anaesthetic/tranquilisation skills … I think they [remote nurses] can do a lot. [T24, p. 6] A mental health nurse practitioner said: For [remote nurses] that’s the safest thing, to sedate somebody. Then they don’t have to worry about being attacked during the middle of the night. [T17, p. 11] A request for sedation and aero-evacuation is embedded in a larger ‘tension’ (in which remote nurses have no stake) of cost shifting for the service. The police do not want to incur the cost of providing overnight security, and the health departments do not want to incur the costs of aero-evacuation, or if the patient is not aero-evacuated, the payments for the nurse’s overtime. Hence the remote nurse’s requests fall to this fertile area of competing financial interests. As an eminent remote participant psychiatrist stated: What does cost shifting result in? … one or both of two things—more sedation or evacuation. Evacuation is a quantum leap in expense but it resolves local problems because their [health departments and police] budgets are different. [T11, p. 6]