S.TRUEMAN PhD THESIS 2016

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8.2.11 Irreversibility in delivering mental healthcare The constitutive elements of technological artefacts; the collection of standards and protocols, user expectations and experience, bureaucratic procedures and rules produce inscribed patterns of use (Hughes, 1983). It is not possible to measure the net effects to which these superimposed inscriptions succeed in shaping the pattern of use or measure the strength of their inscription. All that is known is that the greater the time and technological advancement, the greater the degree of obsolescence. No remote nurse organises the evacuation of a mental health patient to a mental health unit utilising a horse and buggy, telegraphing arrangements by Morse code. Such arrangements are undertaken using computer software to email or a smart phone to make arrangements. The essence underscoring irreversibility has been described as momentum (Hughes, 1983, 1987, 1994). Hughes (1994) described momentum as very much a self-reinforcing process gaining force as the technical system grows ‘larger and more complex’ (p. 108). The use of the Internet by remote nurses delivering mental healthcare is an example of this phenomena. Callon (1986b) stated that the degree of irreversibility depends on (i) the extent to which it is subsequently impossible to go back to a point where that translation was only one among others and (ii) the extent to which it shapes and determines subsequent translations. As discussed planes, email, third generation psychiatric medications, motor vehicles and mobile phones are stock standard ‘tools of trade’ technologies used and taken for granted by remote nurses when delivering mental healthcare. The degree of irreversibility of these technological networks arguably results from a process of institutionalisation. This operates both ways: ‘increased degree of irreversibility is a consequence of stronger institutionalisation and, the other way around,