678 the mental health nurse experience of providing care for people with delirium superimposed on dementia

Introduction
People with severe dementia are frequently cared for by registered mental health nurses due to their often complex cognitive or psychological care needs. This study aimed to explore and describe the experiences of mental health nurses who provide care for people with delirium superimposed on dementia. Methods Activity Theory was used to inform, a mixed methods design. Commencing with semi structured interviews, before further quantitative exploration using a questionnaire. Framework analysis was used for qualitative analysis, followed by descriptive statistical analysis of questionnaire data. Robust 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. Results Five key themes emerged: 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. Conclusion This study is the first to explore the complexities of specifically the mental health nurse context in relation to DSD. The novel application of Activity Theory as a lens offered a unique frame to support exploration of the mental health nurses working environments and experiences.