S.TRUEMAN PhD THESIS 2016

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confined to one—remote generalist nurses—resultant from a meso-level of analysis. As a matter of completeness there can be studies which are macro in focus and still involve obligatory passage points such as Kruse (2013) who examined British mining, exploration, international banks and geopolitics on the artic Spitsbergen, situated in the European High Arctic, between 1904 and 1953. Mager’s (2009) study involved Google’s (the web based search engine) algorithm. Mager examined both website providers’ and users’, practices and conceptualisation of online health information utilising Google. She found that both groups had very different practices and conceptualisations but they had one area of commonality; Google played a central role in their online actions. ‘Google may be seen as an obligatory passage point … [w]ebsite providers adapted their linking strategies to Google’s algorithm and users primarily used the web information provided by Google’ (Mager, 2009, p. 1137). The researcher’s study concerns human actors (remote generalist nurses) being the obligatory passage point, not an algorithm, yet Mager’s finding is relevant, in that two (or more) groups of actors can be attracted to, and use the same obligatory passage but for different reasons. For website providers, Google was best as it is a single search engine, which produced the broadest searchable reach and breadth of the internet. Conversely for web users, Google produced and generated the most search results of any other search engine on a single inquiry. There are three parallels to the present study. Firstly the patient engages with the remote nurse (unaware they are an obligatory passage point) in the capacity of a consumer of goods (e.g., medications, injections) and services (e.g., counselling, nursing care) while the other actors in the healthcare arena undertake the approach as providers of goods and services. This is only noteworthy as both