S.TRUEMAN PhD THESIS 2016

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with remote nurses can be close, distant, regular, variable and multifaceted depending on circumstances. Advice and assistance can usually be grouped around medication orders, organising mental health patient appointments, providing update medical and social patient histories for visiting psychiatrists, medically monitoring (particularly for serious side effects, e.g., Clozapine i.e. agranulocytosis, myocarditis), reporting against established regimes concerning patient depot injections and assisting in Community Treatment Order applications. Beyond these types of interventions, there are interactions with psychiatrists that are less regimented, planned and involve less predictability. There are two types of these less regimented interactions. Mental health crisis presentations, particularly involving violence and aggression, result in rapid and intense interactions. In such circumstances, assistance is primarily sought for two reasons. First, nurses seek telephone medication orders: [Remote nurses] in those settings aren’t interested in the long-term welfare … they’re interested in getting through the next 24 hours and getting through this shift. Sedatives solves that problem. [Psychiatrist, T11, p. 5] Second, nurses may seek authorisation to aero-evacuate mental health patients to regional hospitals. The medication orders primarily relate to the sedation of patients, particularly when there is associated violence and aggression. All nurse participants in the study nominated the prioritisation of obtaining sedative medication orders for such crisis presentations. Only two nurse participants mentioned ‘de-escalation’ as a first response. One nurse participant stated, when responding after hours to violent mental health presentations: