Practical answer
When speech is unreliable, a simple communication passport helps every nurse understand your relative. Observe the patient in a calm familiar setting and document how they show yes, no, stop, pain, thirst, toileting, breathing difficulty, discomfort and a wish for privacy.
This guide may be useful for
- People with aphasia or speech loss
- Families supporting a non-speaking patient
- Nurses meeting a patient for the first time
Map communication from the patient outward
Begin with what the patient can consistently do: eye movement, pointing, gesture, writing, picture board, device selection, facial expression or vocal sound. Test yes and no with known questions and repeat on another occasion before calling a signal reliable.
Record preferred name, language, hearing aids, glasses, positioning, lighting, fatigue pattern and the time usually needed to respond. Include what does not work, such as rapid questions, multiple choices or touch before explanation.
- Tested yes-no signals
- Useful communication methods
- Environment and response time
- Methods to avoid
Related sources:[1]
Use the passport without replacing consent
Address the patient first and present one concrete choice at a time. Show the item or action when helpful, wait for the documented response window and confirm the answer in a different way. A relative may support communication but should not automatically become the decision-maker.
Separate assent, refusal, pain behaviour and inability to answer. For intimate tasks, offer privacy and a stop signal before beginning. If understanding or decision ability is uncertain, pause non-urgent action and use the appropriate clinical and consent pathway.
- Patient addressed first
- One choice at a time
- Stop signal before care
- Uncertainty escalated
Related sources:[1]
Keep the passport current across nurses
Place a dated copy where authorised visiting nurses can find it without exposing private information to unrelated visitors. Include a contact who knows the method and a version date, not a broad claim that one person always interprets correctly.
Review after illness, hospitalisation, medicine change, new device, fatigue change or any disagreement between the passport and observed responses. Record updates and retire outdated copies so different nurses do not follow conflicting signals.
- Controlled access
- Named clarification contact
- Review triggers
- Old versions withdrawn
Related sources:[1]
Primary sources
These sources support the general principles on this page. The individual treating team’s instructions take priority.
- World Health Organization: Integrated people-centred health servicesInternational · health-service guidance
- World Health Organization: Patient safetyInternational or source jurisdiction; general principles only · authoritative public guidance
- World Health Organization: Quality of careInternational or source jurisdiction; general principles only · authoritative public guidance
Sources checked: 2026-08-02
What to consider before arranging a visit
Support that may be relevant
- Patient’s own signals come first
- Reliable and unreliable responses separated
- Response time documented
- Pain and consent checked distinctly
- Changes trigger review
What to prepare and confirm
- Which signal means yes or no
- How long to wait
- Who may clarify information
- Which choices need private discussion
- When communication needs reassessment
Ask about communication support during home nursing
Send a WhatsApp message and our team will help you arrange a home nurse visit. It notes this page and leaves room for your area. The nurse or provider confirms suitability, timing and fees before any visit.
To protect privacy, please don’t send an identity-card number, full medical record or an identifiable wound photo in your first message.
Ask about communication support during home nursingQuestions families ask
Can a family member answer every question for the patient?
They may help explain a tested communication method or history, but the nurse should still address the patient and seek the patient’s own response whenever possible. Decision authority and communication assistance are not the same.
What if yes and no signals change?
Stop relying on the old signal, check fatigue, positioning, hearing, vision and acute health change, and arrange clinical reassessment when the difference is new or unexplained.