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Communicating with your relative in critical care


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Communication is being able to understand and share information through talking, writing, body movements or other signals. It is an important part of our daily lives, and lets us interact with other people.

If your relative is in critical care, they might find it hard to communicate for different reasons. There are ways to help you communicate with your relative. 

If you have any questions or concerns about communicating with your relative, speak to their doctor, nurse or speech and language therapist.

Reasons communication can be difficult

Your relative might find communication difficult for different reasons.

They might:

  • not be very alert
  • get tired easily
  • need help breathing with a breathing machine (ventilator)
  • have lost muscle strength, for example muscles in their face
  • have brain or nerve (neurological) changes, for example a stroke
  • have reduced vision or hearing
  • have had a tracheostomy tube fitted
  • be taking pain medicine or sedation medicine, which might make them feel sleepy or confused

For these reasons, you might find it difficult to communicate with your relative. This can leave both you and them feeling frustrated. Your relative might feel alone, or anxious.

If your relative has had a tracheostomy

A tracheostomy is a procedure where the doctor makes a hole in the front of the neck. A breathing tube is put in the windpipe below the voice box to help you breathe.

A special type of tracheostomy with an inflatable cuff might be needed. A cuff is a small balloon on the tracheostomy tube. When the balloon is blown up (inflated) it makes sure air flows in and out through the tracheostomy.

When the cuff is inflated air does not pass through the voice box and your relative will not be able to use their voice.

When it is safe, the critical care team might deflate the balloon on the tracheostomy and put in a one way valve. This can let your relative use their voice box again so they can make sounds or use their voice to communicate. 

Things you can do to help

There are ways you can help your relative communicate. 

  • Bring their glasses and hearing aids, if they use them.
  • Ask questions that have a simple yes or no answer. For example, ‘Are you feeling better today?’ instead of ‘How are you feeling?’.
  • Encourage them to use facial expressions and gestures rather than their voice.
  • Pay attention and give them more time to communicate.
  • Repeat their answers back to them to make sure you have understood their message.
  • Be clear about the topic of conversation.
  • Make sure there are no distractions and background noise, such as televisions.
  • Speak calmly and clearly, do not shout.
  • Encourage any attempt they make to communicate. You could give them a pen and paper to write down key words if they can.
  • If they have a mobile phone, you could use typing to communicate.
  • Critical care units have iPads with a communicator app. Try using this app to help your relative communicate. 
  • Contact the Speech and Language Therapy Department (contact details on the top right-hand side of this page). They can give advice about using communication aids, such as picture and alphabet charts and electronic communication aids.

Tell a member of staff if your relative’s first language is not English. This will help them to communicate better, and they will be able to arrange an interpreter or signer. You can call the Language Support Team for more support, phone 020 7188 7798



Ref number: 3093/VER4

Date published: September 2020 | Review date: September 2023

© 2020 Guy’s and St Thomas’ NHS Foundation Trust

A list of sources is available on request


Where next?

 Contact us

If you have any questions, or need advice, contact the Speech and language therapist team at your hospital. 

Guy’s Hospital 

020 7188 6233     

St Thomas’ Hospital

020 7188 2522

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