S.TRUEMAN PhD THESIS 2016

311

decision. This occurs also in encounters by remote nurses with patients while delivering mental healthcare. Often there will be necessary follow-up appointments or further encounters in deciding the best mental healthcare intervention, in response to the changing condition of the patient. An example of two obligatory passage points is when certain oral second generation psychotropic medications (e.g., clozapine) are administered (first obligatory passage point), which must have follow-up blood tests to monitor for serious side-effects. Each subsequent blood test could be classified an obligatory passage point, because without them, the medication should not be administered. Secondly Mager (2009) found that both website providers and users used the Google search engine because of the convenience it provided to the different group’s requirements. In this study the usage or engagement of remote nurses by the various actors is also driven in part or full, depending on the actor, because of convenience. If you are a mental health patient in a remote community there is overwhelmingly only one institution which provides healthcare namely, the primary healthcare centre. It is therefore convenient to go there with a mental health issue rather than travel by road, boat or airplane to another remote community. Hence it is equally convenient for all actors to work through the remote nurse. The convenience emanates from the nurses being the only actor physically embedded in the remote location. It would be absurd to travel many thousands of kilometres from a metropolitan location, every time the actor (e.g., a doctor) wanted to know or request something, in relation to a patient or mental healthcare concern. It is simply not feasible, hence for example, the telephoning of remote nurses. The issue of convenience is central to the remote nurse being engaged, and assuming the obligatory passage point.