A major aspect of nursing care within intensive care environments is communication. If nursing communication with patients is to be both effective and therapeutic nurses need to understand the principles of communication and identify the purposes of nurse-patient interactions. The main purpose of this article is to review and examine normal communication channels and the actual and potential barriers to communication between nurses and patients who are intubated or have tracheostomies. The assessment of these patients' needs for communication, planning, implementation and evaluation of nursing to meet them are discussed, and also implications for the future.