Alalawi, Badryah Nasser
(2025)
Analysing intercultural health language: a linguistic (im)politeness study of nursing communication in Saudi hospitals.
PhD thesis, University of Nottingham.
Abstract
(Im)politeness remains understudied in Saudi intercultural healthcare settings, where differing norms may influence healthcare practitioners’ perspectives of (im)politeness as well as overall communication outcomes. This study examines how nurses from different cultural backgrounds – Saudi, Filipino and Indian – perceive (im)politeness based on their intra-professional work experience in intercultural medical contexts.
My study adopts a mixed-method design, combining quantitative discourse completion tasks (DCTs) and qualitative semi-structured interviews. The DCT data were collected from nurses’ responses to hypothetical scenarios involving directive speech acts, requests and advice giving, with 50 registered nurses from each group: Saudi, Filipino and Indian. Semi-structured interviews were conducted with 12 registered nurses, four from each group, to gain insights into their perspectives on (im)politeness in the context of their intra-professional communication. The DCT data were analysed using a taxonomy combining two frameworks, Brown and Levinson’s (1987) politeness strategies and Blum-Kulka, House and Kasper’s (1989) Cross-Cultural Speech Act Realisation Project (CCSARP), to identify politeness strategies and markers in nurses’ responses. The interview data were analysed using Brown and Levinson’s (1987) politeness theory and Culpeper’s (2011a) conceptualisation of impoliteness, to understand nurses’ perceptions of (im)politeness in hospital contexts.
The findings revealed that while Saudi, Filipino and Indian nurses reported a primary preference for an indirect communication style, particularly for directive speech acts, the Indian nurses reported significantly greater usage of a direct style compared to Saudi and Filipino nurses. Additionally, there were variations in nurses’ reported use of address terms, with Filipino and Indian nurses using them notably more commonly than Saudi nurses, who rarely reported using them. Such differences in communication styles, along with varying cultural expectations, suggested potential gaps in nurses’ intercultural communicative competence (ICC), which might contribute to communication breakdown.
Building on these findings, my study recommends integrating intercultural training courses for Saudi and non-Saudi nurses prior to clinical work. Such training could address cultural variations in nurses’ communication norms, perceptions of (im)politeness and strategies to reduce miscommunication. Practical components, such as case studies of nursing interactions and role-playing exercises, could enhance nurses’ awareness of cultural differences in language use and foster adaptable communication skills. To maintain long-term improvement, intercultural training should be ongoing rather than one-time, supplemented by mentorship programmes pairing Saudi and non-Saudi nurses. These research-informed recommendations provide nursing policymakers with practical guidance for improving intercultural interaction in Saudi’s multicultural healthcare sector.
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