S.TRUEMAN PhD THESIS 2016

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embody and measure a set of relations between heterogeneous elements’ (Akrich, 1992, p. 205). The term inscription is not ‘deterministic … [in] that action is inscribed, grafted or hard-wired into an artefact’ (Hanseth & Monteiro, 1998). An objectivistic stance views artefacts determining its (any) use and, conversely, a subjectivist stance views a technological artefact as a malleable interpretation. Akrich (1992) explained the concept of inscription in the following way: Designers thus define actors with specific tastes, competencies, motives, aspirations, political prejudices, and the rest, and they assume that morality, technology, science, and economy will evolve in particular ways. A large part of the work of innovators is that of ‘inscribing’ this vision . (p. 208, emphasis added) If a United States or European laboratory designs a third-generation psychotropic drug marketed as a ‘better treatment’ with less side-effects, this has ramifications in the actions and choices of the actors within the remote nurses’ social world. The ‘drug of choice’ is that which is now preferentially adopted as ‘front-line’ medication, based on the current (inscribing) advice of the artefact’s (medication) technological experts; pharmacists, psychiatrists, administrators; actioned through policies and procedures. The ‘first-generation’ (previous first choice) psychotropic medications are ‘de-scribed’ from a global distance, and the new ‘front-line’ medications of choice are substituted. The second generation medications are archetypal of the process of inscription. Risperdal medication, for example, is administered as ‘long acting’: 28-day slow release injectable dosages. The remote nurse’s patterns of use (actions) in delivering mental healthcare are changed through inscription. As the inscription is widely taken up by the various groups in the social world, patterns of action become widely uniform and coordinated.