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patient or issue, but also for information to decide or inform them of what assistance they can render. If a psychiatrist, residing outside of the community of where the remote nurse is working, is telephoned for a medication phone order for sedation, then they are totally reliant on the nurse for the necessary and requisite information to decide whether to authorise the administration of the sedative or not. If they do authorise the order, then they are again reliant on the nurse, for they are the only actor who will give the injection. With reference to Figure 8.7, the psychiatrist cannot directly assist the patient; they must work with and through the remote nurse. The dominance of the remote nursing workforce causes and maintains remote general nurses as the obligatory passage point in the delivery of mental healthcare. 8.3 Addressing Criticisms and Challenges to Actor-Network Theory In this section the researcher addresses the critiques and some of actor-network theory’s controversial claims. The researcher anticipated, early in the study, concerns and potential problems with using actor-network theory in this analysis. Three main criticisms are relevant for consideration in this study; the principle of generalised symmetry, the risk of adopting an objective and un-reflexive stance when using actor-network theory and the Machiavellian orientation of actor-network theory. These critiques are drawn from works by Amsterdamska (1990), Walsham (1997), Calas and Smircich (1999), Munir and Jones (2004), Whittle and Spicer (2008) and Gad and Bruun Jensen (2010). The most controversial debate concerning actor-network theory is the principle of general symmetry. This principle posits that humans and non–humans must be equally evaluated as entities and actors of producing action. Technologies are not seen as neutral or