{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T21:08:18Z","timestamp":1780434498241,"version":"3.54.1"},"reference-count":42,"publisher":"AACN Publishing","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,15]]},"abstract":"<jats:p>Mechanical ventilation is lifesaving yet harmful when paired with deep sedation and immobility. The ABCDEF, or intensive care unit liberation bundle (assessment and treatment of pain, spontaneous awakening and breathing trials, judicious choice of analgesia\/sedation, delirium prevention\/management, early mobility, and family engagement) mitigates these risks, improving survival, reducing delirium and coma, shortening time receiving ventilation, and promoting recovery. This article synthesizes evidence for the awake-and-walking intensive care unit, in which wakefulness and mobility are the default. We define the role of the advanced practice registered nurse in reliable implementation of this model: embedding bundle elements into workflows, aligning sedation and mobility targets, coordinating interprofessional teams, and driving culture change through measurement and feedback. A case example illustrates a patient\u2019s trajectory under high versus low adherence. We close with pragmatic strategies to overcome workflow fragmentation, staffing variability, and safety concerns, mapping barriers to solutions such as protocol standardization, nurse-respiratory therapist coleadership, daily goal alignment, and data transparency.<\/jats:p>","DOI":"10.4037\/aacnacc2026649","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T20:31:53Z","timestamp":1780432313000},"page":"160-166","source":"Crossref","is-referenced-by-count":0,"title":["Liberation Playbook: Pain, Sedation, Sleep, and Mobility Led by Advanced Practice Registered Nurses"],"prefix":"10.4037","volume":"37","author":[{"given":"Kali","family":"Dayton","sequence":"first","affiliation":[{"name":"Kali Dayton is ICU Sedation and Mobility Consultant, Dayton ICU Consulting, Washington."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lago J.J.","family":"Valdez","sequence":"additional","affiliation":[{"name":"Lago J.J. Valdez is Associate Professor and Clinical Coordinator, Respiratory Care Program, Victoria College, Victoria, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Bocchese","sequence":"additional","affiliation":[{"name":"Steve Bocchese is Director of Clinical Practice and Education\u2013Critical Care, Virtua Health, and Postdoctoral Nursing Research Fellow, Nursing Institute, Cleveland Clinic, Cleveland, Ohio."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A.","family":"Connell","sequence":"additional","affiliation":[{"name":"Kathryn A. Connell is Assistant Professor, Department of Biobehavioral Health Sciences, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing; Senior Fellow, Leonard Davis Institute of Health Economics; and Clinical Nurse 2, Penn Medicine Pennsylvania Hospital, 418 Curie Boulevard, Philadelphia, PA 19104 (kacrn@nursing.upenn.edu)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2471","reference":[{"issue":"1","key":"2026060216314986600_b1-0370160","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1164\/rccm.201610-2075ST","article-title":"An Official American Thoracic Society\/American College of Chest Physicians clinical practice guideline: liberation from mechanical ventilation in critically ill adults. 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