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.