S.TRUEMAN PhD THESIS 2016

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MOUs are all revised and updated in line with changes in knowledge, technologies and environmental/ecological changes. Built on an installed base : a boundary object ‘does not grow de novo ; it wrestles with the inertia of the installed base and inherits strengths and limitations from that base’ (p. 611). The process of revising boundary objects necessarily involves building upon previous courses of action. Some may be adopted, strengthened or rejected. 8.2.8.3 Knowledge Policies and procedures produce reoccurring modes of action when the same or similar circumstances occur. The most influential effect generated is knowledge (Latour, 1992). Knowledge for remote generalist nurses takes many forms such as speech, understandings, and the techniques and skills of the remote nurses (Latour & Woolgar, 1979). The written format (computerised or ‘hard copy’) is the most recognisable form of knowledge within the remote nurse’s social world. Knowledge is the collection and end product of a whole series of disparate heterogeneous ‘bits and pieces’ (Law, 1992, p. 4). So that when a remote nurse consults a procedure manual concerning what psychiatric drug to administer to a mental health patient, that knowledge resulted from chemists, laboratories, research trials, machines, experiments, articles, skills and training, universities, all of which are separate, but when situated in a particular order, materialise in directing that action of the remote nurse. This ‘heterogeneous engineering’ (Law, 1987, p. 113) is the organising of elements from the social, the technical, the conceptual, and the textual and so converted (or ‘translated’) into a heterogeneous scientific product and action (e.g., mental healthcare). The remote nurse is able to provide the correct medication in the correct dosage for the mental health