Abstract Professional practice in critical care settings is characterized by the application of relevant theories, research and evidence-based guidelines to clinical practice. However, critical care nurses’ knowledge and skills in adhering to evidence-based protocols and guidelines for avoiding ventilator-associated pneumonia are inadequate. The aim of the study was to evaluate critical care nurses’ knowledge and skills in adhering to best-practice endotracheal suctioning recommendations and ventilator bundles, to develop and validate instruments to evaluate the care of mechanically ventilated patients, and to evaluate the effectiveness of continuing education on critical care nurses’ knowledge and skills, with a focus on ventilator bundles. In the first study, a descriptive and cross-sectional correlation study was conducted to evaluate critical care nurses’ (n = 40) endotracheal suctioning practices in relation to current best-practice recommendations. In the second study, a descriptive design with a literature review was conducted to assess the effectiveness of educational programmes in preventing ventilator-associated pneumonia. In the third study, an instruments validation study was conducted to develop and test the psychometric properties of the Ventilator Bundle Questionnaire (VBQ) and Observation Schedule (VBOS). In the fourth study, the effectiveness of human patient simulation education was evaluated among thirty (n = 30) critical care nurses who were randomly allocated to intervention and control groups (n = 15 each). Critical care nurses’ knowledge and skills in adhering to best-practice endotracheal suctioning recommendations and ventilator bundles continues to be inadequate. However, educational programmes were linked to significant improvements in learning and clinical outcomes. The VBQ and VBOS were developed and shown to have acceptable psychometric properties (CVI 0.99–1.0, ICC 0.93–1.0). After human patient simulation education, the mean skill scores of the intervention group increased significantly (pt*g = 0.02). Educational programmes may have a significant impact on clinical outcomes and thus, patients’ safety and quality of care, through improvements in nurses’ knowledge and skills in adhering to evidence-based guidelines in critical care settings. The VBQ and VBOS can provide an objective method measuring whether evidence-based guidelines are being used in clinical practice. In addition, there was a significant transfer of learned skills to clinical practice following human patient simulation education. / Tiivistelmä Teho-osastoilla ammatillinen erityisosaaminen edellyttää tutkitun tiedon, teorioiden sekä näyttöön perustuvien hoitosuositusten soveltamista kliiniseen käytäntöön. Kuitenkin tehohoitajien tiedot ja taidot noudattaa näyttöön perustuvia hoitokäytäntöjä ja suosituksia hengityslaitehoitoon liittyvän keuhkokuumeen ehkäisyksi ovat olleet puutteellisia. Tutkimuksen tarkoituksena oli arvioida tehohoitajien tietoa ja taitoa noudattaa hyväksi havaittuja hengitysteiden imukäytäntöjä sekä hengityslaitehoitoon liittyviä hoitosarjakäytäntöjä, kehittää ja validoida mittareita hengityslaitehoitoa saavien potilaiden hoidon laadun arvioimiseksi sekä arvioida täydennyskoulutuksen vaikuttavuutta tehohoitajien tietoihin ja taitoihin noudattaa hengityslaitehoitoon liittyviä hoitosarjakäytäntöjä. Ensimmäisessä osatyössä arvioitiin kuvailevan ja korrelatiivisen tutkimusasetelman avulla tehohoitajien (n = 40) alahengitysteiden imukäytäntöjä suhteessa hyväksi havaittuihin toimintakäytäntöihin. Toisessa osatyössä arvioitiin kuvailevan kirjallisuuskatsauksen avulla koulutusinterventioiden vaikuttavuutta hengityslaitehoitoon liittyvän keuhkokuumeen ehkäisyssä. Kolmannessa osatyössä kehitettiin ja testattiin hengityslaitehoitoon liittyvä hoitosarjakysely (VBQ) sekä havainnointimittari (VBOS). Neljännessä osatyössä arvioitiin simulaatiokoulutuksen vaikuttavuutta satunnaistetussa koeasetelmassa interventio- (n = 15) ja kontrolliryhmän (n = 15) välillä. Tehohoitajien tiedot ja taidot noudattaa hyväksi havaittuja hengitysteiden imukäytäntöjä sekä hengityslaitehoitoon liittyviä hoitosarjakäytäntöjä olivat edelleen puutteellisia. Kuitenkin koulutusinterventioiden vaikuttavuus kliinisiin hoitotuloksiin sekä oppimistuloksiin oli merkittävä. VBQ- ja VBOS-mittareiden psykometriset ominaisuudet osoittautuivat hyväksyttäviksi (CVI 0,99–1,0, ICC 0,93–1,0).Simulaatiokoulutuksen jälkeen interventioryhmän taidot noudattaa hoitosuosituksia lisääntyivät merkittävästi (pt*g = 0,02). Koulutusinterventioiden kliininen vaikuttavuus potilasturvallisuuden ja hoidon laadun kehittämisessä voi olla merkittävää, kun hoitajien tietoa ja taitoa noudattaa näyttöön perustuvia hoitosuosituksia lisätään kliinisessä tehohoitotyössä. VBQ- ja VBOS-mittarit voivat tarjota objektiivisen tavan arvioida tutkitun tiedon siirtymistä kliiniseen käytäntöön. Simulaatiokoulutuksen jälkeen opittujen taitojen siirtovaikutus kliiniseen käytäntöön oli merkittävä.

Tissue plasminogen activator (tPA) is most effective the faster it is able to be administered to a patient that has been affected by stroke. A Stroke Code is a strategy that acute care facilities implement to reduce the time from diagnosing a stroke to administering tPA. The purpose of this study was to determine if the initiation of a Stroke Code in an acute care hospital reduces the door-to-needle time for patients affected by a stroke. In particular, does a Stroke Code reduce door-to-needle times. The research was conducted using data from April 1, 2014 to December 31, 2014 (pre-Stroke Code period) and September 1, 2015 to December 31, 2016 (post-Stroke Code period). The population of this study was treated at Holston Valley Medical Center in Kingsport, Tennessee. The analysis revealed a decrease in door-to-needle times after a Stroke Code was implemented at the acute care facility.

Bakgrund: Avvänjning från respirator är en stor del av intensivvården. Där övergången från att andas med hjälp av respirator till att hitta den egna spontana andningen är en komplex uppgift för intensivvårdsjuksköterskan och kräver både tid och kompetens. Syfte: Syftet var att beskriva intensivvårdssjuksköterskans erfarenheter av vuxna patienters avvänjning från respirator. Metod: Kvalitativ design med semistrukturerade intervjufrågor användes. Studien innehöll totalt åtta stycken deltagare från två sjukhus i Sverige. Innehållsanalys med induktiv ansats användes vid analysen. Resultat: När analysen var klar framkom 5 stycken kategorier. Kategorierna var: Att förbereda och informera patienten, att patienten inte är stressad, att använda avvägningsprotokoll, betydelse av samarbete och kommunikation samt patientens tid i respiratorn har betydelse. Resultatet belyste sjuksköterskans erfarenheter kring en individuell vård, samarbetet och kommunikation. Diskussion: Ett protokoll som efterföljs har visat sig förbättra avvänjningen för patienten, samtidigt bör en individuell planering finnas med. Kommunikationen och närhet med patienten är viktig för att kunna åtgärda oro och stress och skapa trygghet. Slutsats: Resultatet påvisade att det var viktigt med kommunikation mellan intensivvårdssjuksköterskan, patienten och läkaren. Det var också viktigt att ge patienten bra förutsättningar till att lyckas med avvänjningen. / Background: Weaning from the respirator is a large part of intensive care. The transition from breathing with the help of a respirator to finding its own spontaneous breathing is a complex task for the intensive care nurse and requires both time and competence. Aim: To describe the intensive care nurse's experience of adult patients weaning from respirator. Method: Qualitative design with semi-structured interview questions was used. The study included a total of eight participants from two hospitals in Sweden. Content analysis with inductive approach was used in the analysis. Results: When the analysis was completed, five categories. The categories were: Prepering and informing the patient, that the patient is not stressed, using balancing protocols, importance of cooperation and communication and the patient´s time in the respirator is important. The result highlighted the nurseś experiences regarding individual care, cooperation and communication. Discussion: A protocol that was followed has been shown to improve the respitory weaning for the patient while at the same time a individual planning should be involved. Communication and vicinity for the patient are important in order to be able to remedy anxiety and stress and create security. Conclusion: The result showed that communication between the intensive care nurse, the patient and the doctor is important. It is also important to give the patient the best possible conditions to succeed in weaning. / <p>Godkännandedatum: 2019-11-08</p>

Background: “Nurses provide essential care to the millions of people who are hospitalized each year as a result of illness or injury” (Smith, 2012, p. 172). The Institute of Medicine reported approximately 44,000-98,000 patients die annually resulting from a medical error, and health care errors ranked among the top 10 for the leading causes of death in the United States (Smith, 2012). Problem: Nurse competence impacts safe and quality nursing, and several research studies investigated the measurement of nurse competence among nurses in various nursing settings (Flinkman et al., 2016). However, a review of the research revealed limited studies in the emergency department (ED) setting and in the United States (O’Leary, 2012). Method: This study implemented a quantitative nonexperimental research design using the combination of an instrumental case study and a cross-sectional survey for this study’s sample. An Internet-based SurveyMonkey questionnaire collected data on nurse competence from registered nurses (RNs) working in the ED at a San Francisco Bay Area hospital. Part I of the questionnaire integrated Meretoja, Isoaho, and Leino-Kilpi’s (2004) Nurse Competence Scale (NCS) consisting of 73 closed-ended clinical indicators divided into seven competence areas. Participants rated their level of competence and frequency of use for each clinical indicator. Part II of the questionnaire obtained background information about participants. A total of 21 out of 110 potential participants completed the survey. Results: The data analysis using Statistical Package for Social Sciences (SPSS) provided descriptive and nonparametric correlation statistics. Descriptive statistics described survey respondents. The least and most competent areas were ensuring quality and managing situations, respectively. The most frequent length of nursing experience was at least 60 months and the most frequent number of hours worked was at least 65 hours per 2-week period. Nonparametric correlation statistics, including Kendell’s tau-b and Spearman’s rho, identified significant relationships. A significant relationship existed between the frequency of using clinical skills and level of competence for four of the seven competence areas. A significant relationship existed between the background factor of experience, both as an RN and an ED RN, and level of competence for many clinical indicators. A significant relationship existed between the background factor of hours worked and level of competence for one clinical indicator. Conclusion: Despite the small sample size of 21 survey respondents, this study revealed findings consistent with the existing research on nurse competence. This study offers implications and recommendations for practice relative to nurse competence, nurse competence assessment, and transitions to new settings of nursing practice to support the nursing profession and safe and quality nursing.

Interhospitala överföringar har ökat de senaste åren och tidigare forskning har fokuserat på transportfasen utifrån olika perspektiv. Det saknas däremot forskning kring intensivvårdssjuksköterskans upplevelse av att ta emot och vårda patienter efter interhospital överföring, därför valde vi att fokusera på detta ämne. Syftet med studien är att beskriva intensivvårdssjuksköterskans upplevelser av vårdandet av patienter efter en interhospital överföring. En kvalitativ intervjustudie genomfördes. Nio specialistsjuksköterskor inom intensivvård med erfarenhet av att vårda patienter efter interhospitala överföringar intervjuades. Dataanalysen är baserad på kvalitativ innehållsanalys och resulterade i åtta subteman och tre teman: Upplevelse av kontroll, Upplevelse av ambivalens kring överföringar, Upplevelse av samhörighet med andra. Det upplevs positivt att ta emot och vårda patienter efter interhospital transport när det finns möjlighet till förberedelse, både praktiskt och mentalt. Samma känsla infinner sig när mötet med patienten och anhöriga blir bra och när samarbetet på avdelningen och mellan enheterna är tillfredställande. Dock upplevs viss stress om det finns brister i dokumentation och informationsöverföring eller om mottagandet av patienten och dess närstående känns otillräckligt. Resultatet illustrerar komplexiteten av mottagandet efter överföring och betonar vikten av en bra överlämning. Utvecklingsområden finns såsom enhetliga journalsystem mellan regioner och att undvika interhospitala överföringar på grund av resursbrist. / Interhospital transfers have increased in number over the last years and at this point there is a good amount of research focussed on the transport phase of transfers that even includes different perspectives. There is, however, a lack of research concerned with the aftermath of a patient transfer such as taking over and caring for the patient. We therefore decided to make this the focus of our study. The aim of this study was to investigate the experience of critical nurses of caring for patients after interhospital transfer. We conducted a qualitative interview study where we interviewed nine critical care nurses from two mid-level general intensive care units. Data analysis was performed using qualitative content analysis. This resulted in 8 sub-themes and 3 main themes: Experience of control, Ambivalence regarding transfers and Experiencing fellowship. The result demonstrates that critical care nurses have a positive experience of receiving and caring for patients after interhospital transfer given that they had to opportunity to be mentally and practically prepared. Meeting the patient and their family members also generates a positive experience when the cooperation and information transfer between units has been satisfactory. Critical care nurses experience stress when they perceive threats to patient safety such as incomplete transfer of information or documentation or when the encounter with the patient and their family members was marked by problems. The result shows the complexity of taking over patients after transfer and the importance of a high-quality patient handover. Areas of improvement for transfers are seen by introducing a unified national medical record system and avoiding interhospital transfers due to lack of resources.

Le manque de rétention des infirmières en soins critiques au Québec déjà observé depuis plusieurs années perdure et s’est aggravé depuis la pandémie de COVID-19. Les programmes d’orientation à l’embauche permettraient de contribuer à la rétention des infirmières débutant dans ces milieux. À ce jour, cependant, aucune revue de la littérature n’a été effectuée dans l’objectif de mieux comprendre ces effets. Une revue rapide des écrits a été réalisée dans le but de mieux comprendre les effets des programmes d’orientation sur la rétention des infirmières en soins critiques. Les caractéristiques des programmes menant à des effets favorables ont également été recherchées. L’approche de Dobbins (2017) a été utilisée aux fins d’élaboration de cette revue rapide. Sept écrits ont pu être sélectionnés et analysés selon des critères d’inclusion. Les études considérées devaient se rapporter à des programmes ou interventions de formation auprès des infirmières débutant en soins critiques. Les études devaient se dérouler dans un milieu de soins critiques, tel que l’unité de soins intensifs adulte, pédiatrique ou néonatale. L’analyse des études recensées montre une rétention améliorée chez les infirmières après l’implantation d’un programme d’orientation. Les résultats indiquent également des améliorations en ce qui a trait au recrutement, taux de départ, connaissances, satisfaction, coûts et disponibilité des lits. Les programmes d’orientation qui ont eu des effets bénéfiques sur la rétention des infirmières comportent plusieurs éléments : le recourt à la théorie « novice à experte » de Benner (1984), le préceptorat accompagné de mentorat ou le recours à une personne-ressource, la formation des précepteurs, les méthodes évaluant le progrès des recrues et l’emploi de stratégies éducatives variées. Cette revue rapide des écrits a permis d’alimenter la réflexion sur les effets des programmes d’orientation sur la rétention des infirmières en soins critiques, tout en mettant en évidence des pistes pour poursuivre l’étude de ces programmes. / Critical care settings in Quebec are struggling with low retention of nursing staff which has worsened under the effect of the COVID-19 pandemic. Orientation programs could help to overcome low retention rates. To date, no review of the literature has been carried out with the aim of better understanding these effects. A rapid review of the literature was conducted to better understand the effects of orientation programs on the retention of critical care nurses. Program characteristics leading to positive effects on retention were also investigated. The Dobbins (2017) approach was used for the development of this rapid review. Seven writings were selected and analyzed according to inclusion criteria. The studies considered had to relate to training intervention or orientation programs for nurses new to critical care. Studies had to take place in a critical care setting, such as the adult, pediatric or neonatal intensive care unit. The analysis of the studies reviewed shows improved retention among nurses after implementation of an orientation program. The results also point to improvements in recruitment, attrition rates, knowledge, satisfaction, costs, and bed availability. Orientation programs that have had beneficial effects on the retention of nurses include several elements: the use of Benner’s "novice to expert" theory (1984), preceptorship, mentoring or the use of a resourceful person, training of preceptors, evaluation of the progress of recruits and the use of various educational strategies. This study provides an initial insight into the characteristics of orientation programs to be reviewed in the critical care unit to increase the nurse retention while highlighting avenues for further study of these programs.

The intent of this thesis was to examine compassion fatigue in nurses through analysis of research studies conducted within the past five years in an effort to identify predisposing factors to the experience of compassion fatigue. Individual and institutional factors were identified as well as current strategies to assist with management of compassion fatigue. Findings indicated that being new to practice, having a trait negative affect, being younger in age, having a history of exposure to trauma and working in high emotionally stressful units predisposed individuals to the experience of compassion fatigue. Institutional factors included a lack of managerial support, organizational commitment, group cohesion, work engagement and conflicting expectations of the nurse. Institutional interventions to assist in mitigating compassion fatigue include improving managerial support, developing group cohesion and communication and providing continuing education opportunities. Institutions can also assist by offering training in resiliency techniques such as negative thought pattern identification, meditation, peer-to-peer discussions, journaling about traumatic experiences, identification and maintenance of personal/professional boundaries and physical wellness through exercise and yoga. These proposed interventions address institutional accountability in health care worker wellness as defined by the quadruple aim. Such interventions also address use of Watson’s Caring Theory to emphasize the importance of nurse wellness as essential to creating caring nurse-patient relationships.

The aim of the study was to describe the perceptions of critical care nurses concerning family witnessed resuscitation, presenting arguments for or against the practice thereof. A quantitative, descriptive and exploratory approach was used. For the study, a non- probability convenience sample of 100 critical care nurses from five critical care units were used. A combined open-ended and closed-ended questionnaire was used. The majority of critical care nurses in the study disapproved of the idea of family witnessed resuscitation. They believed it to be traumatic for relatives, threatening to the resuscitation process and increasing litigation. Although the dominant feeling was one of disapproval, some critical care nurses felt that family witnessed resuscitation was beneficial to relatives. Recommendations for future practice included incorporation of educational programmes for critical care nurses concerning family witnessed resuscitation and providing training to deal with the stresses of family witnessed resuscitation. / Health Studies / M.A (Health Studies)

O objetivo deste estudo foi analisar como se manifestam as características definidoras (CD) dos diagnósticos de enfermagem (DE) Padrão Respiratório Ineficaz (PRI) e Ventilação Espontânea Prejudicada (VEP) e as CD identificadas na literatura para o conceito “ventilação” em pacientes adultos hospitalizados em unidade de terapia intensiva com uso de oxigenoterapia. Tratou-se de um estudo de validação clínica diagnóstica realizado com 626 pacientes. Foram utilizadas as técnicas estatísticas de Análise de Correspondências Múltiplas para realizar o diagnóstico diferencial e Análise de Classe Latente para determinar três níveis de gravidade a partir das CD de PRI, VEP e do conceito “ventilação”, relacionando-os com o modo ventilatório empregado: a) pacientes com menor gravidade em uso de oxigenoterapia através de ventilação espontânea (VE); b) pacientes com gravidade intermediária em uso de oxigenoterapia através de ventilação mecânica não invasiva (VMNI) e; c) pacientes com maior gravidade em uso de oxigenoterapia através de ventilação mecânica invasiva (VMI). As CD que apresentaram maiores valores de sensibilidade para a subamostra em VE foram “fadiga”, “alterações no volume corrente”, “pressão inspiratória diminuída” e “pressão expiratória diminuída”. As CD que apresentaram maiores valores de sensibilidade para a subamostra em VMNI foram “alterações na frequência respiratória”, “alterações no volume corrente”, “relação ventilação/perfusão alterada”, “gases sanguíneos arteriais alterados” e “pressão expiratória diminuída”. As CD que apresentaram maiores valores de sensibilidade para a subamostra em VMI foram “cooperação diminuída”, “inquietação aumentada”, “alterações na frequência respiratória”, “gases sanguíneos arteriais alterados” e “hipóxia”. A partir destes achados, sugere-se que o DE VEP seja excluído da NANDA-I e que sejam incorporadas as CD de VEP que constituíram parte do modelo de classe latente com melhor ajuste ao DE PRI. / The objective of this study was to analyze the behavior of the defining characteristics (DC) of Nursing diagnosis (ND) Ineffective Breathing Pattern (IBP) and Impaired Spontaneous Ventilation (ISV) and DC found in the literature for "ventilation" concept in adult patients hospitalized in intensive care unit in oxygen therapy. The study was a diagnostic clinical validation conducted with 626 patientes. Multiple Correspondence Analysis was used to perform a differential diagnosis and Latent Class Analysis was used to determine three severity levels from the DC of PRI, VEP and of the concept “ventilation", relating them to the ventilation mode used: a) patients with minor oxygen therapy through spontaneous ventilation (SV); b) patients with intermediate severity oxygen therapy through noninvasive mechanical ventilation (NIMV) and; c) patients with severe oxygen therapy through invasive mechanical ventilation (IMV). The DC that showed higher sensitivity for the class in SV were "fatigue", "changes in tidal volume", "decreased inspiratory pressure" and "decreased expiratory pressure”. The DC that showed higher sensitivity for the class in NIMV were "changes in respiratory rate", "changes in tidal volume", "altered ventilation/perfusion ratio", "altered arterial blood gases" and "decreased expiratory pressure". The DC that showed higher sensitivity for the class in IMV were “decreased cooperation", "increased restlessness", "changes in respiratory rate", "altered arterial blood gases" and "hypoxia." Finally, it is suggested that the VEP diagnosis be excluded from the NANDA-I and its DC which formed part of the latent class model with best adjustment be incorporate as DC to ND PRI. / Esta investigación tiene como objetivo analizar cómo se manifiestan las características definidoras (CD) de los diagnósticos de enfermería (DE) Patrón Respiratorio Ineficaz (PRI) y Deterioro de la Ventilación Espontánea (DVE) y las CD identificadas en la literatura para el concepto "ventilación" en pacientes adultos hospitalizados en unidad de cuidados intensivos con oxigenoterapia. Fue un estudio de validación clínica de diagnósticos de enfermería. Compusieron la muestra 626 pacientes. Se utilizaron técnicas estadísticas de Análisis de Correspondencias Múltiple para hacer el diagnóstico diferencial y Análisis de Clase Latente para determinar tres niveles de gravedad desde las CD de PRI, DVE y del concepto "ventilación", relacionándolos con el modo de ventilación empleado: a) pacientes con menos gravedad en uso de oxigenoterapia a través de ventilación espontánea (VE); b) pacientes con gravedad intermedia en uso de oxigenoterapia a través de ventilación mecánica no invasiva (VMNI) y, c) pacientes con mayor gravedad en uso de oxigenoterapia a través de ventilación mecánica invasiva (VMI). Las CD que mostraron mayor sensibilidad para la clase en VE fueron “fatiga”, “cambios en el volumen tidal”, “disminución de la presión inspiratoria” y “disminución de la presión espiratoria”. Las CD que mostraron mayor sensibilidad para la clase en VMNI fueron “cambios en la frecuencia respiratoria”, “cambios en el volumen tidal”, “relación ventilación/ perfusion cambiada”, “gases en sangre arterial cambiados” y “disminución de la presión espiratoria”. Las CD que mostraron mayor sensibilidad para la clase en VMI fueron “cooperación disminuida”, “inquietación demasiada”, “cambios en la frecuencia respiratoria”, “gases en sangre arterial cambiados” y “hipoxia”. A partir de estos resultados, se sugiere que el DE DVE se suprimido de la NANDA-I y que las CD del DE DVE que constituían parte del modelo de clase latente con mejor ajuste se incorporan al DE PRI.

Patients in the intensive care unit (ICU) setting are prone to develop muscle weakness and the causes are multi-factorial. Muscle strength in adult, critically ill patients on mechanical ventilation decreases with immobility. The influence of muscle strength on different muscle groups and its influence on progressive mobility in the adult, critically ill patient on mechanical ventilation has not been examined. Identifying muscle strength in this patient population can benefit overall muscle health and minimize muscle deconditioning through a progressive mobility plan. The objective of this dissertation was to describe muscle strength in different muscle groups and to describe the influence of muscle strength on mobility in critically ill adult patients on mechanical ventilation (MV). Fifty ICU patients were enrolled in this descriptive, cross sectional study. Abdominal core, bilateral hand grip and extremity strength was measured using three measurement tools. Mobility was measured using the following scale: 0=lying in bed; 1=sitting on edge of bed; 2=sitting on edge of bed to standing; 3=walking to bedside chair and 4=walking >7 feet from the standing position. Predictors of mobility were examined using stepwise regression. Abdominal core, bilateral hand grip and extremity strength demonstrated statistically significant relationships with all variables. Extremity strength accounted for 82% of the variance in mobility and was the sole predictor (β=0.903; F=212.9; p=0.000). Future research addressing the outcomes of implementing a mobility protocol in this patient population and prioritizing when such a protocol should be implemented would be beneficial to ongoing plans to decrease MV, ICU and hospital days. Muscle strength tests implemented at the bedside are crucial to implementing a progressive mobility plan for critically ill adults while they are on MV therapy.