In hospital
A tube prevents speech, not thought. This page is for nursing and medical staff, for patients and for their families, for the moments when understanding must happen at once and without a voice.
Words Within Reach is a free and openly licensed communication aid. It is not a medical device, not medical advice, and not a care protocol. This service is no substitute for any ward procedure or for the opinion of a speech and language therapist.
The moments when a board is useful
- An intubated or tracheostomised patient, conscious, who cannot produce any sound.
- Waking up after an operation, when speech is still not possible.
- Sudden aphasia, before any assessment has been possible.
- A patient who does not speak the language of the ward, in the emergency department as in outpatient clinics.
- A person too tired to write, but able to point.
The critical care literature documents what these situations cost: the loss of speech in a conscious ventilated patient comes with frustration, stress and anxiety, and the difficulty is shared by the nursing staff, who are the first communication partners at the bedside. Work on communication boards in intensive care has also shown that patients have precise views on the words and pictures that would be useful to them.
What can be done in thirty seconds
- Open the ready-made boards and choose the one that matches the situation.
- Or else print the board and place it within reach of the patient’s gesture.
- Modelling two or three cells yourself while speaking, to show what they are for, without asking anything in return.
Why paper matters more here than elsewhere
- Hands are busy, and a screen needs to be held, unlocked, recharged.
- Personal devices are not always allowed, and the ward’s computers are locked down.
- A sheet can be wiped clean or replaced, and a laminated board stays in the room.
- The team changes with every shift: a board on display is understood by whoever walks in, with no explanation.
- A sheet of paper does not run out of battery in the middle of the night.
Where to put it
Visible at all times, turned towards the patient, within reach of their gesture, on the side of the hand that moves. A board kept in a drawer or pinned behind the bed is no use. If the patient can point only with their eyes or a minimal movement, a board with large cells is worked through cell by cell by the communication partner, who waits for confirmation at each step: partner-assisted scanning.
Closed questions are not enough
Asking “are you in pain?” and waiting for a nod tests a hypothesis; it does not bring one in. A patient must be able to say what nobody has asked about: anxiety, thirst, noise, wanting to see someone, needing to be moved into another position, refusal. That is exactly what a board allows, and that is why it also carries the words that are unwelcome.
What the institution can do
- Printing in bulk and laminating, without asking anyone: the boards are freely licensed, see licence and re-use.
- Adapting the vocabulary to a ward: the words of an intensive care unit are not those of a maternity unit. See my boards.
- Translating the labels into the languages most often spoken in the ward: the pictures stay the same, only the words change.
- Writing to us about a situation the boards do not cover: contact.
No patient data needs to reach us, and nothing leaves the device: what is composed on a board stays on the device that displays it. See the frequently asked questions.
Sources
- Communicating with conscious and mechanically ventilated critically ill patients: a systematic review, open access on PubMed Central.
- Communication boards in critical care: patients’ views, PubMed record.
- Effect of a multi-level intervention on nurse-patient communication in the intensive care unit: results of the SPEACS trial, open access on PubMed Central.
- Assistive technology, World Health Organization fact sheet.