Participation in antimicrobial stewardship among intensive care unit nurses: a cross-sectional study based on the...

This study aimed to investigate antimicrobial stewardship participation and its associated factors among intensive care unit (ICU) nurses based on the Capability, Opportunity, Motivation, and Behavior (COM-B) model.

A cross-sectional survey was conducted among ICU nurses from 11 hospitals across China in March 2026. Data on demographic and occupational characteristics were collected using a general information questionnaire. Antimicrobial stewardship participation and its influencing factors were assessed using the ICU Nurses' Participation in Antimicrobial Stewardship Behavior and Influencing Factors (ASP-BF) Scale, and nursing professional self-efficacy was measured using the Nursing Professional Self-Efficacy (NPSE) Scale.

A total of 497 ICU nurses were included. The mean scores were 48.80 ± 9.86 for capability (possible range: 13-65), 38.42 ± 10.60 for opportunity (possible range: 11-55), 82.55 ± 16.86 for motivation (possible range: 23-115), 59.94 ± 13.57 for behavior (possible range: 16-80), and 29.60 ± 4.45 for NPSE (possible range: 7-35). Structural equation modeling (SEM) showed that capability (β = 0.41), opportunity (β = 0.84), and NPSE (β = 0.77) were positively associated with motivation, and motivation was positively associated with behavior (β = 0.75; all p < 0.001).

ICU nurses had generally favorable levels of capability, opportunity, motivation, behavior, and NPSE in relation to antimicrobial stewardship participation. Motivation was directly associated with participation behavior, while capability, opportunity, and NPSE were associated with behavior through motivation. In addition, antimicrobial stewardship training was associated with better participation behavior. Future interventions should focus on strengthening institutional support, improving multidisciplinary collaboration and workflow conditions, and providing structured training to enhance nurses' participation in antimicrobial stewardship.