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The use of light and no sedation is gaining currency in the intensive care unit, resulting in more conscious patients. Due to mechanical ventilation, patients are unable to communicate verbally, and may feel frustration. Communication tools may help; however, they are not used systematically in clinical practice. Based on “complex interventions” and a qualitative approach, a communication tool was modified, tested, and evaluated in this study. The tools consisted of a tablet with communication software and a laminated “communication book” with identical structure. Seven nonsedated, mechanically ventilated patients tested the tools and were observed in field studies. Findings show that challenges in using communication tools may be related to the patient, nurses, and/or technology. Patients may experience difficulties in using the tools, especially if they are extremely fatigued or have cognitive impairments and/or reduced muscle strength. Communication tools were not always necessary; however, some found them very helpful and the only way of conveying a message. Findings also show that the best way to facilitate communication is through a systematic communication strategy initiated by the nurse.