Emotions as social informational cues: A multi-source diary study explaining how nurses' perceptions of patients' relatives shape patients experiences of missed nursing care

Background: Patient-reported missed nursing care is a critical indicator of care quality, while existing research focuses on nurses' workload and resource constraints as primary triggers, the role of emotional and interpersonal factors during nurse–patient encounters remains underexplored. Objectives: To examine how nurses' emotions and perceptions of patients' families jointly influence patient-reported missed nursing care, using the Emotions as Social Information (EASI) model. Design: A multi-source, nested, diary study design. Setting: The study was conducted in internal medicine, surgical, orthopedic, and geriatric wards across two public hospitals. Participants: 142 registered nurses and 638 patients formed 638 nurse–patient dyads. Methods: Over 3–5 morning shifts, nurses completed surveys assessing their perceptions of families and emotions during specific encounters. Patients concurrently reported on missed nursing care. Mixed linear models analyzed the nested data. Results: Significant interaction emerged: (1) High positive emotions combined with perceiving families as a resource increased missed care (β = 0.028, p < 0.05); (2) High negative emotions combined with perceiving families as a burden increased missed care (β = 0.086, p < 0.05); and (3) High negative emotions combined with viewing families as their own resource decreased missed care (β = − 0.235, p < 0.01). Conclusions: This study introduces the emotions as social information model to healthcare, revealing how nurses' emotions and perceptions of families jointly shape patient-reported missed care. Findings underscore the need for healthcare organizations to support nurses in managing their emotions and optimizing family involvement to enhance care delivery and patient satisfaction.