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Background: People with severe dementia are frequently cared for by registered mental health nurses due to their often complex cognitive or psychological care needs. This may present challenges in practice due to the inter relatedness of physical and mental health that accompanies dementia, not least the presentation of delirium superimposed on dementia (DSD). This study aimed to explore and describe the experiences of mental health nurses who provide care for people with DSD. This will support better understanding of what influences or impacts their work. Methodology and Methods: Using Activity Theory to guide the study throughout, a mixed methods exploratory sequential design was constructed. Semi structured interviews were undertaken to collect qualitative data, before a quantitative exploration through questionnaire development and completion. Data analysis was undertaken utilising framework analysis in the qualitative phase, and descriptive statistics in the quantitative phase. Integration of data was undertaken, and findings presented in an activity system graphic. Participants were registered mental health nurses working in 24-hour care settings for people with dementia. Findings: Five key themes emerged from the data: 1. For RNMHs to use tools (such as scores or guidelines), they need to see them as useful and contextually relevant. Whilst they are aware of tools, they may choose not to use them if they do not see the value in them. 2. Knowing the person for whom they provide care is central and personal. The RNMHs favour aesthetic ways of knowing and use this to guide their care provision. 3. Hierarchy within the multidisciplinary team remains, however this is not seen as a negative. The RNMHs feel supported and secure within their wider MDT. 4. Burdens of care felt by the RNMHs is driven by the care environment and care context. 6. There remains a disconnection of mental and physical health in both care environments and how the RNMHs see their role.