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International Conference on Humanities.
Education.
Language, and Culture Interpersonal Metafunction in the Linguistic Landscape of Healthcare: Implications for Nursing English Instruction Gabriel Fredi Daar Universitas Katolik Indonesia Santu Paulus Ruteng.
INDONESIA *Corresponding Email: freddydaar@gmail.
Abstract This study examined linguistic landscape (LL) data in healthcare settings through the lens of interpersonal metafunctions in Systemic Functional Linguistics (SFL), focusing on Mood structure.
Modality.
Personal Pronouns, and Evaluative Language.
The primary objective was to analyze how hospital signage and public health messages use language to influence behavior and interaction.
Additionally, the study explores the pedagogical implications of LL data in teaching English for Specific Purposes (ESP) to nursing students.
The research employed a qualitative descriptive method, analyzing selected LL texts from hospitals, such as instructional signs and public Data collection involved documentation of LL texts from two healthcare settings.
Ruteng Public Hospital and Saint Rafael Cancar Hospital.
The data analysis followed the SFL framework, categorizing linguistic features based on their interpersonal functions and communicative intent.
Findings indicated that hospital LL texts predominantly use declarative and imperative mood structures to deliver direct and authoritative messages.
Although explicit modality markers are often absent, indirect expressions of obligation suggest expected compliance.
The use of personal pronouns, particularly the implied second-person "you" fosters engagement, while evaluative language reinforces International Conference on Humanities.
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These linguistic choices enhance clarity, promote adherence to healthcare regulations, and establish a respectful yet persuasive tone.
The study concluded that LL texts serve as authentic materials for teaching effective professional communication to nursing students.
Integrating LL analysis into ESP instruction enhances studentsAo understanding of pragmatic language use in healthcare.
prepares them for real-world interactions with patients and medical professionals.
Keywords: linguistic landscape.
interpersonal metafunction.
healthcare setting.
English for specific purpose INTRODUCTION Language has an important role in shaping human interaction, particularly in professional settings such as Halliday & Matthiessen's .
Systemic Functional Linguistics (SFL) framework identifies three metafunctions of language: ideational, interpersonal, and Among these, the interpersonal metafunction is essential in constructing social relationships.
It conveys attitudes, and negotiates meaning between interlocutors.
In the healthcare context, this function is reflected in linguistic landscapesAiwritten and spoken texts found in hospitals, clinics, and other medical facilities.
LL influences communication between healthcare providers and patients.
The study of linguistic landscapes (LL) has gained increasing attention.
The study has become a lens for understanding how language is used in public spaces.
It facilitates or hinders communication (Shohamy, 2.
However, limited research has explored its implications for Nursing English instruction, particularly in Indonesia.
In Indonesia, where English is a foreign language, healthcare professionals often face communication challenges when interacting with international patients or using medical resources in English (Nikolaou, 2.
International Conference on Humanities.
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English, or bilingual formats (Peled, 2.
The extent to which these linguistic elements contribute to or hinder effective communication remains underexplored.
By examining the interpersonal metafunction in these texts, this study seeks to uncover the communicative strategies embedded in the linguistic landscape and their relevance to English for Specific Purposes (ESP) instruction in nursing.
Several landscapes in healthcare settings.
For instance.
Seman, et .
examined linguistic diversity in hospitals and found that inadequate multilingual signage affects patient comprehension and safety.
Similarly.
Cenoz & Gorter .
explored hospital linguistic landscapes in South Africa, highlighting how power relations are constructed through language use in medical spaces.
Benedicto .
through his study suggested expanding the use of bilingual signage to facilitate effective communication, particularly in hospital environments, by implementing a bilingual signage policy.
Alhazmi .
studied the Impact of COVID-19 Pandemic Linguistic Landscapes on Lifestyle.
Health Awareness and Behavior.
The study highlighted the impact of linguistic landscapes in public spaces on shaping peopleAos perceptions and behaviors, as well as their responses to urgent and exceptional situations like COVID-19.
These studies show the benefits of linguistic landscape to change peopleAos perception, behavior and Thus, the studies suggested to provide multilingual LL in public spaces in hospital.
Despite its growing body of study on linguistic landscape of healthcare context, the study on this topic in healthcare in Indonesia remains unexplored.
Moreover, the exploration of interpersonal metafunction within the International Conference on Humanities.
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5 Tahun 2025 linguistic landscape of healthcare settings is rarely studied, particularly in relation to Nursing English Existing studies have primarily focused on multilingualism, translation accuracy, and doctor-patient interactions, yet few have examined the pragmatic functions of language in hospital environments and their pedagogical implications.
Given the growing globalization of healthcare and the necessity for Indonesian nurses to enhance their communication skills, conducting research to address this gap is essential.
The present study aims to analyze the interpersonal metafunction in the linguistic landscape of Indonesian healthcare settings and explore its implications for Nursing English instruction.
Specifically, it seeks to identify the communicative strategies embedded in hospital signage, medical documents, and patient information materials and assess how these linguistic elements can be integrated into ESP curricula for nursing students.
By investigating these aspects, this study is expected to provide valuable insights into how linguistic landscapes can serve as authentic teaching materials in Nursing English courses.
Understanding how politeness strategies, modality, and engagement markers function in medical discourse will help develop more contextually relevant instructional materials for future nurses.
This study contributes to both linguistic landscape studies and ESP pedagogy.
It bridges the gap between linguistic analysis and applied language teaching.
highlights the role of public texts in shaping healthcare communication and offers practical recommendations for improving Nursing English instruction in Indonesia.
METHODS
Research Design This study employed a qualitative research design with a linguistic landscape analysis approach to examine International Conference on Humanities.
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Qualitative research is suitable for this study as it focuses on understanding language use in its natural context and interpreting meaning beyond surface-level textual analysis (Denzin & Lincoln, 2.
Specifically, the study applies Systemic Functional Linguistics (SFL) (Halliday & Matthiessen, 2.
to analyze the interpersonal metafunction in linguistic landscapes, identifying how language is used to establish social relations, express attitudes, and negotiate interactions in hospital signage, patient information materials, and medical documents.
In addition to linguistic landscape analysis, this study integrates semiotic analysis to explore the visual and textual features of healthcare communication materials.
Given that linguistic landscapes are multimodal in nature, combining textual and visual elements, a semiotic approach allows for a more comprehensive interpretation of meaning-making strategies.
The study adopts an exploratory research approach to identify patterns and trends in healthcare communication, which can inform the development of Nursing English instructional materials.
Participants The study involved two healthcare settings in Indonesia: Ruteng Public Hospital and Saint Rafael Hospital Cancar.
These institutions were selected based on their diverse linguistic environments, the presence of bilingual or English-language materials, and their relevance to nursing education.
The linguistic landscapes of these institutions provide a rich source of data for analyzing the interpersonal metafunction in healthcare Additionally, two English teachers from the Faculty of Health at Unika Santu Paulus Ruteng are included in the The teachers were selected based on their International Conference on Humanities.
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Their perspectives on the effectiveness of linguistic landscape materials in learning professional communication provide valuable insights into the instructional implications of the study.
Data Collection The study collects three types of data: .
photographs of linguistic landscape elements .
, hospital signage, patient instructions, consent forms, and health promotion material.
, .
interviews with English teachers, and .
document analysis of English-language healthcare texts used in hospitals and medical training.
The photographs were taken from designated hospital areas, including reception desks, emergency rooms, pharmacies, and patient wards, ensuring a diverse representation of healthcare communication materials.
Semi-structured interviews were conducted with English teachers to gain insights into their perceptions of the linguistic landscape and its role in English for Nursing The interviews focus on the clarity, appropriateness, and pedagogical value of the linguistic elements found in healthcare settings.
Additionally, document analysis was done on hospital forms, patient brochures, and nursing manuals to examine how interpersonal meanings are conveyed through modality, politeness strategies, and engagement markers.
Data Analysis The data analysis followed a Systemic Functional Linguistics (SFL)-based (Halliday Matthiessen, metafunction marker, consisting of mood structures, modality, personal pronouns, and evaluative language.
The textual data from hospital signage and medical documents are categorized based on their function e.
, directive.
International Conference on Humanities.
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was applied to analyze qualitative data from interviews.
The objective of analyzing the interview data was to identify emerging patterns related to English teachersAo perspectives on the role of linguistic landscapes in English The findings obtained from textual and interview data were triangulated to ensure validity.
It was also conducted to provide a comprehensive understanding of how the interpersonal metafunction in healthcare linguistic landscapes can inform Nursing English
RESULTS AND DISCUSSION
The analysis of language functions in the linguistic landscape of hospitals provides a clear depiction of the language used in public spaces within the context of English for Nursing learning.
This analysis assists researchers in selecting and determining relevant topics and language components aligned with the types of linguistic landscapes present.
Furthermore, examining language functions offers a comprehensive portrayal of the learning context for nursing students in English language The study aimed at describing the interpersonal metafunction of linguistic landscape in healthcare settings and its pedagogical implication to English language learning to nursing student.
Thus, the data presented in the study were in the form linguistic landscape .
mage and verbal sign.
and interview notes.
Interpersonal metafunction discussed how language functions to help people involve in interaction with others.
The components of interpersonal metafunctions of International Conference on Humanities.
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Thus, the interpersonal metafunction of linguistic landscape in the study will be presented based on categorization of language functions.
expressive, and representative/informative, that suit the linguistic landscape found in the healthcare settings.
Directive Language Function Directive language functions refers to the use of language as medium to change peopleAos mind and The expected results in the listeners are doing what is hoped by the speaker.
Directive function of language plays a vital role in influencing the listeners to think and behave as expected by the speaker (Humaira et , 2.
In the context of communication through verbal and image, directive functions of language aims to influence the readersAo behavior and mind (Seruni & Hamzah, 2.
In the study, directive functions of language represented through verbal signs, image and combination of verbal and image.
The signs were designed to influence and persuade the hospital users .
ealth providers, patient and visitor.
to do as requested or instructed in the signs.
The signs primarily focus on patients improving selfawareness and responsibility to use the facilities and hospital services.
In light with its directive functions, linguistic landscape in hospital settings carried out interpersonal metafunction, serving its role as a medium of persuading listeners or readers.
The following data represents interpersonal metafunction which is analyzed through mood structures, modality, personal pronouns, and evaluative language.
Based on the above linguistic landscape (LL) data, the interpersonal metafunctions of LL in the healthcare settings are as follow:
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Mood Structures Mood refers to the grammatical organization of a clause that determines its function in interaction, such as a statement .
, question .
, or command .
(Halliday & Matthiessen, 2.
Mood structures shape how information is delivered and how social roles .
, authority in medical setting.
are The LL data in the study showed that mood structures are in the form of declarative and imperative ItAos found some imperative sentence such as ambil obat, buanglah sampah pada tempatnya.
The imperative sentences are utilized to direct the patients and hospital users to do as written on the signs.
The patients are directed to take the medicines at department as shown in the signs.
Likewise the trash should be thrown in its The declarative and imperative signs showed social roles of hospital and health laboratory as a formal settings.
Thus, the placement of the LL at hospital public space functions as guide for hospital users to do and behave as regulated by the hospital authorities.
Figure 1.
Data samples on Mood structure in Directive language .
Personal Pronouns In the context of interaction, the use of personal pronouns .
I, you, we, the.
indicate social relationships, levels of politeness, and involvement of participants in communication (Halliday & Matthiessen.
Personal pronouns affects how participants or listeners respond to the information conveyed.
In the International Conference on Humanities.
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LL data displayed in the healthcare settings carried relationships, politeness and involvement of the sign maker in the communication.
In terms of directive functions, some LL data of hospital settings donAot use personal pronouns.
It indicated that hospital authorities as the signs makers donAot have social relationships with the listeners or readers.
Furthermore, the unavailability of Personal pronouns indicted the absence of participantAos involvement in the communication.
See the following Figure 2.
Data samples the absence of Direct Personal Pronouns in Directive language functions It is found one LL data containing Personal Pronoun AuWeAy kita.
Ayo Kita Ciptakan Generasi Anti Narkoba.
The use of the signs aims to invite and persuade the readers .
ospital user.
to contribute to create antinarcotic generation in Indonesia.
The use of Personal Pronoun AuWeAy in the signs indicated the involvement of sign makers in the communication.
In collaboration with the participants, the sign makers take parts in promoting and applying antinarcotic generation.
Furthermore, the use of the Personal pronoun implied level of politeness and social relationships between sign makers and participants.
See the following sign.
International Conference on Humanities.
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Data sample of Personal Pronoun in Directive language .
Evaluative Language Evaluative language includes words and phrases that express attitudes, emotions, or judgments about a subject.
It can be positive, negative, or neutral and is often used in persuasion or reassurance (Halliday & Matthiessen, 2.
In the study, neutral and negative evaluation are found.
The neutral evaluation shown in neutral language.
AuAlur Pasien Rawat InapAy, shows neutral evaluation of language in LL data.
The language displayed in LL functions to direct patients during their time as in-patient in hospital.
The messages conveyed through verbal language brings neutral effects on the readers.
The study also found one LL data in negative evaluation of language.
Dimohon untuk tidak mengambil gambar foto/video/audio di area pelayanan Rumah Sakit.
It indicated prohibition for the hospital users to take pictures/video/audio in the hospital Based on the signs, itAos assumed that there will be certain consequences if the visitors break it.
See the following figures.
Figure 5.
Data samples of evaluative language in Directive language functions International Conference on Humanities.
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This function is primarily associated with the speaker's subjective expression rather than merely transmitting information or requesting action (Halliday & Matthiessen, 2.
The expressive function focuses on the "addresser" and aims to communicate their psychological state.
It often reflects personal experiences, opinions, or sentiments (DaltonPuffer, 2.
Expressive language is often used to evoke emotions in readers, making texts more engaging and relatable.
Furthermore, it is essential in persuasive speech and rhetoric, where speakers use emotional appeals to influence audiences (Arista & Murni, 2014.
Rini & Wagiran, 2.
In the study, one LL data contains expressive functions of language.
The following presents the LL data of healthcare settings, analyzed using interpersonal metafunctions, consisting of Mood structure.
Modality.
Personal Pronoun and Evaluative language:
Figure 6.
Data samples on expressive language function The interpersonal metafunctions analysis of linguistic landscape text of Terima kasih untuk tidak merokok sebab Rumah Sakit adalah Kawasan bebas dari asap rokok, "Thank you for not smoking, as the hospital is a smokefree area", encompasses Mood Structure.
Modality.
Personal Pronoun, and Evaluative Language, as follows:
International Conference on Humanities.
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Mood Structure The mood structure of this text is declarative, as it presents a factual statement that the hospital is a smokefree area.
However, an imperative clause is also implicitly present in the phrase.
Terima kasih untuk tidak merokok "Thank you for not smoking," which functions as an indirect command or polite request for individuals to refrain from smoking.
Modality There is no explicit expression of modality .
uch as must, should, ma.
However, the phrase "Thank you for not smoking" carries an implicit obligation modality, as it subtly conveys the expectation that readers should comply with the hospital's no-smoking policy.
Personal Pronoun There is no explicit use of personal pronouns such as you.
However, the subject is implied, referring to visitors or anyone present in the hospital environment.
In other words, the message is addressed to the general public without specifying a particular individual.
Evaluative Language The phrase "smoke-free area" conveys a positive evaluation of the hospital environment, emphasizing that it is clean and healthy, free from smoke pollution.
The expression Terima kasih untuk tidak merokok "Thank you for not smoking" also employs a positivity strategy, adopting a polite and appreciative approach rather than a direct prohibition like No smoking!.
This reflects a more persuasive and non-confrontational language strategy.
The text employs polite, persuasive, and implicit interpersonal strategies in conveying the no-smoking policy, prioritizing appreciation and factual statements over explicit International Conference on Humanities.
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This function is primarily associated with declarative sentences that provide data, explanations, or instructions, often without expressing emotions or personal opinions (Halliday & Matthiessen, 2.
The informative function, also known as the referential function, focuses on the message itself and its content, aiming to deliver accurate and verifiable information (Dalton-Puffer, 2.
The following data were analyzed using interpersonal metafunctions of language.
Mood structure.
Modality.
Personal pronoun and Evaluative language:
Mood Structure The Informative Language Functions of LL data in the study are in declarative Mood Structure.
The analysis of Mood Structure in Linguistic Landscape (LL) based on Systemic Functional Linguistics (SFL) helps to understand how a text conveys interpersonal meaning in public In the given textsAi Enam Sasaran Keselamatan Pasien, "6 Patient Safety Goals," Makan Makanan Bergisi Setiap Hari dan Tablet Tamba Darah "Eat Nutritious Food Every Day," and "Iron Supplement Tablets,"Aithere are variations in mood structure that reflect different communicative purposes, whether as information, instructions, or persuasive appeals.
In the phrase "6 Patient Safety Goals," the mood structure is declarative, as it presents information about six key objectives related to patient safety.
There is no interpersonal element that explicitly urges or instructs the reader to take action.
The primary function of this phrase is naming or labeling, meaning that it categorizes a specific concept within the context of hospital safety standards.
This phrase serves to raise awareness among medical International Conference on Humanities.
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Figure 7.
Data samples on Mood Structure in Informative language functions In contrast, the sentence "Eat Nutritious Food Every Day" employs an imperative mood structure, as it contains a directive or encouragement to consume nutritious food In Indonesian, imperative sentences often omit the explicit subject, but it is understood that the intended subject is the reader or listener.
The use of this structure reflects a persuasive purpose, where the text not only provides information but also encourages behavioral change by promoting a healthy diet.
Meanwhile, the phrase "Iron Supplement Tablets" follows a declarative mood structure, similar to "6 Patient Safety Goals," as it merely identifies a type of medication without issuing any direct instructions or appeals.
The primary function of this phrase is also naming or labeling, aiming to introduce or inform the audience about a particular health product.
Thus, this text is more informative rather than persuasive.
The differences in mood structures across these three texts demonstrate how language can serve various communicative functions in public discourse, whether to provide information, give instructions, or persuade an audience.
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Modality Modality refers to how a statement expresses possibility, necessity, permission, or obligation (Halliday & Matthiessen, 2.
In the linguistic landscape (LL) analysis of the texts "6 Patient Safety Goals," "Eat Nutritious Food Every Day," and "Iron Supplement Tablets," the level of modality can be observed through explicit and implicit expressions related to obligation or In the phrase "6 Patient Safety Goals," there is no explicit modality because the text is declarative and purely However, obligation modality is implied, as patient safety is generally considered a mandatory standard in the medical field.
Although words such as must or mandatory are not explicitly used, the phrase suggests that there are rules or procedures that healthcare workers and hospital visitors must follow to ensure patient Meanwhile, in "Eat Nutritious Food Every Day," obligation modality is present at a medium-high level, even though it is not explicitly stated with words like should or This sentence uses an imperative structure, implicitly conveying a directive or encouragement for the reader to adopt healthy eating habits.
As for the phrase "Iron Supplement Tablets," there is no explicit modality, as it merely names a product without any interpersonal element indicating obligation or possibility.
However, within its context, it can be assumed that necessity modality is implied.
For instance, for individuals experiencing anemia or iron deficiency, taking iron supplement tablets may be necessary, even though the text itself does not directly state this obligation.
Personal Pronouns The phrase "Your 5 Moments for Hand Hygiene" includes the second-person possessive pronoun "Your," International Conference on Humanities.
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This use of "Your" personalizes the message, making it feel like an individual responsibility rather than a general rule.
By employing this pronoun, the text encourages direct engagement, making healthcare professionals or individuals feel accountable for their hand hygiene practices.
Unlike impersonal statements like "The 5 Moments for Hand Hygiene," which might seem like a generic guideline, using "Your" strengthens the connection between the message and the Figure 8.
Data sample on Personal Pronouns in Informative language functions Additionally, the text does not include other personal pronouns such as "we," "they," or "us," which means that the responsibility is placed entirely on the reader rather than shared among a group.
The absence of explicit subject references to an authority or organization also means the statement relies on individual commitment rather than institutional enforcement.
This choice aligns with persuasive communication strategies that encourage compliance through a sense of personal duty rather than external pressure (Tili & Barker, 2.
Evaluative Language From an evaluative language perspective, the phrase "5 Moments for Hand Hygiene" conveys a positive and precautionary stance.
The word "Hygiene" carries a strong International Conference on Humanities.
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The phrase suggests that adhering to these five moments is essential for maintaining a clean and healthy environment, implicitly reinforcing the importance of good hygiene practices without resorting to explicit commands.
This evaluative approach makes the message more persuasive while maintaining a professional and respectful tone.
Furthermore, the phrase "5 Moments" implies a structured and well-defined guideline rather than a vague or optional suggestion.
The specificity of "5 Moments" signals that there are clear and recognized instances where hand hygiene is necessary, reinforcing the idea that compliance is both practical and evidence-based.
The evaluative strength of this phrase lies in its ability to promote best practices in a non-coercive manner, making it more likely that the intended audience will adopt and internalize the recommended hygiene behaviors.
Implications of Using Linguistic Landscape (LL) Data from the Perspective of Interpersonal Metafunctions in English Language Teaching for Nursing Students Incorporating linguistic landscape (LL) data into English language teaching (ELT) for nursing students interpersonal communication skills.
According to Systemic Functional Linguistics (SFL) (Halliday & Matthiessen, 2.
, the interpersonal metafunction focuses on how language is used to establish relationships, express attitudes, and engage in interaction.
LL data of the study .
ospital signs, instructions, and warning.
contain various interpersonal elements, including Mood structure.
Modality.
Personal Pronouns, and Evaluative Language, which can enhance nursing studentsAo ability to use English effectively in professional healthcare settings.
analyzing these aspects, students can gain insights into International Conference on Humanities.
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From a Mood structure perspective.
LL data in hospitals include declarative and imperative structures that serve different communicative purposes.
For instance, signs like "Thank you for not smoking" use a declarative form to state a fact, whereas "Wash your hands before treating patients" employs an imperative structure to give direct instructions.
Teaching nursing students to recognize and produce these structures helps them understand and apply different speech functions in patient communication, such as giving advice, issuing polite directives, and making factual statements in clinical settings (Daar, 2.
The use of modality in LL data can enhance students' understanding of degrees of obligation, possibility, and politeness in healthcare communication .
e Gagne et al.
Modal verbs that appear indirectly in the study, influence how instructions are perceived by patients and healthcare workers.
By analyzing these modal expressions in hospital signage or patient care protocols, nursing students develop a nuanced understanding of how to convey authority, suggestion, or permission when communicating with patients and colleagues.
This skill is important to balance medical necessity with patientcentered care (Bosher, 2.
Personal pronouns and evaluative language in LL data shape interpersonal relationships in healthcare Signs using "your" .
, "Wash your hands") create a sense of personal responsibility, while those avoiding pronouns .
, "Hand hygiene is essential") sound more neutral and general.
Similarly, evaluative language in phrases like "Clean hands save lives" reinforces positive health behaviors and motivates compliance through persuasive strategies.
Teaching nursing students to analyze and apply these linguistic features enables them to communicate effectively with International Conference on Humanities.
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It ensures their language aligns with professional, ethical, and culturally sensitive communication standards in nursing practice (He et al.
, 2011.
Fadliah & Sugirin, 2.
CONCLUSION
The study concluded that the analysis of linguistic landscape (LL) data using interpersonal metafunctions communication and English language teaching for nursing The LL texts examined demonstrate the strategic use of Mood structure.
Modality.
Personal Pronouns, and Evaluative Language to convey essential messages in hospital environments.
Declarative and imperative Mood structures serve different communicative functions, from stating facts to giving direct instructions, ensuring clarity and effectiveness in conveying health-related information.
These structural choices highlight the importance of The role of Modality in LL texts reflects varying degrees of obligation and politeness, shaping how instructions and recommendations are perceived.
While explicit modal verbs may not always be present, implied modality, such as indirect expressions of obligation, plays a crucial role in guiding behavior.
This finding highlighted the necessity for nursing students to develop modal competence in English.
It allows them to issue professional yet empathetic directives in patient care settings.
Understanding how modality functions in hospital communication enables students to balance medical authority with patient-centered interaction.
Personal Pronouns and Evaluative Language in LL texts influence interpersonal relationships and audience engagement.
The use of implied or explicit pronouns determines whether messages feel personal, directive, or neutral, while International Conference on Humanities.
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evaluative REFERENCES