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Implement and test unit-wide patient-nurse assisted communication strategies (SPEACS). SPEACS improved nurse-patient communication outcomes; effects on patient care quality and resource use are unknown. Prospective, randomized stepped-wedge pragmatic trial of 1440 adults ventilated ≥2 days and awake for at least one shift in 6 ICUs at 2 teaching hospitals 2009-2011 with blinded retrospective medical record abstraction. 323/383 (84%) nurses completed training; their communication knowledge (p.001) and satisfaction an