S.TRUEMAN PhD THESIS 2016

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Chewing gum had not been envisaged or conceived as a substitution for cigarettes. What was known was that any substitute had to include and address the chemical nicotine. Subsequently nicotine chewing gum was developed. This level of outcome uncertainty and flexibility is a feature of delivering remote mental healthcare. At an initial mental health presentation, the remote general nurse may not know what network needs to be created. Based on their general nursing skills a nurse would know that a patient is mentally unwell, for example if they are shouting that they believe they are God or Jesus Christ. They may not know the psychiatric classification for the psychotic behaviour or what type and amount of psychiatric medication is required (i.e. the final outcome), but they do know the patient is mentally unwell, delusional and requires a mental health intervention. At this stage the final network and outcome is not known, but by being present the nurse assumes an obligatory passage point for that patient’s care. The preceding section has discussed the concept of an obligatory passage point and related it to remote nurses delivering mental healthcare. The researcher has justified this with reference to the literature. There exists a gap in the literature concerning remote nurses and the concept of using obligatory passage points when discussing the delivery of remote mental healthcare. A number of studies, in a variety of settings, have been referred to which have used the obligatory passage point. Analogous situations and parallel findings were discussed to support the first finding, of remote nurses assuming the obligatory passage point.