COM-B模型在护士临床决策行为中的应用进展
Application Progress of the COM-B Model in Nurses’ Clinical Decision-Making Behavior
DOI: 10.12677/acm.2026.1672554, PDF,    科研立项经费支持
作者: 何 莉*：大连大学护理学院，辽宁 大连；刘美玲, 刘艳钰, 尹 敏#：大连大学附属中山医院护理部，辽宁 大连
关键词: COM-B模型；临床决策；护士；研究进展；COM-B Model； Clinical Decision-Making； Nurses； Research Progress
摘要: 护士临床决策行为受多重个体与情境因素共同影响，其形成机制与干预路径仍有待系统阐明。本综述系统阐述了COM-B模型(能力–机会–动机–行为模型)的起源、概念及其在护士临床决策行为研究中的应用价值与现状，涵盖影响因素识别、测评工具开发、共享决策、循证实践落实及干预方案构建等方面。现有证据表明，COM-B模型能够从多层面整合护士决策行为的关键影响因素，为理论驱动的干预设计提供清晰框架，并在促进循证实践方面显示出较好的应用潜力。然而，其应用仍受到研究设计类型、测量工具专属性及情境依赖性的限制。未来研究需结合多方法与情境化干预，进一步检验其在改善护士决策行为及相关临床结局中的有效性与可推广性。
Abstract: Nurses’ clinical decision-making behavior is influenced by multiple individual and contextual factors, and its underlying mechanisms and intervention pathways have yet to be systematically elucidated. This review provides a comprehensive overview of the origins and core concepts of the Capability-Opportunity-Motivation-Behavior (COM-B) model and examines its application and current status in research on nurses’ clinical decision-making. The review covers key areas including the identification of influencing factors, development of measurement instruments, shared decision-making, implementation of evidence-based practice, and construction of intervention strategies. Existing evidence indicates that the COM-B model can integrate critical determinants of nurses’ decision-making across multiple levels, offering a clear framework for theory-driven intervention design and demonstrating considerable potential in promoting evidence-based practice. Nevertheless, its application is constrained by limitations related to study design, the specificity of measurement tools, and contextual dependency. Future research should adopt multimethod approaches and context-sensitive interventions to further evaluate the effectiveness and generalizability of COM-B-informed strategies in improving nurses’ clinical decision-making and related clinical outcomes.
文章引用：何莉, 刘美玲, 刘艳钰, 尹敏. COM-B模型在护士临床决策行为中的应用进展[J]. 临床医学进展, 2026, 16(7): 512-520. https://doi.org/10.12677/acm.2026.1672554

参考文献

[1] Parveen, Z., Zahoor, A., Anjum, B., Perveen, A., Yasmeen, S., Sultan, A., et al. (2025) The Impact of Nurses Clinical Decisions on Patient Safety and Quality of Care. NURSEARCHER (Journal of Nursing & Midwifery Sciences), 5, 31-36. [Google Scholar] [CrossRef] 
[2] Banning, M. (2008) A Review of Clinical Decision Making: Models and Current Research. Journal of Clinical Nursing, 17, 187-195. [Google Scholar] [CrossRef] [PubMed]
[3] Saharuddin, S., Nurachmah, E., Masfuri, M., Gayatri, D. and Yona, S. (2025) Clinical Decision-Making in Nursing in the Emergency Department: Systematic Literature Review Synthesis. Salud, Ciencia y Tecnología, 5, Article No. 1705. [Google Scholar] [CrossRef] 
[4] Bordbar, S., Radinmanesh, M., Bahmaei, J., Rad, H.F. and Yusefi, A.R. (2025) Investigating the Level of Nurses’ Participation in Physicians’ Clinical Decisions and the Factors Affecting It: Evidence from a Cross-Sectional Study from Nurses’ Perspectives. BMC Health Services Research, 25, Article No. 1063. [Google Scholar] [CrossRef] [PubMed]
[5] Park, M., Gu, M. and Sok, S. (2022) Path Model on Decision‐Making Ability of Clinical Nurses. Journal of Clinical Nursing, 32, 1343-1353. [Google Scholar] [CrossRef] [PubMed]
[6] Alharbi, A., Alkubati, S.A., Albaqawi, H., Ali, A.Z., Hamed, L.A., Mohammed, S., et al. (2025) Relationship between Nursing Work Environment and Clinical Decision-Making among Saudi Nurses: Psychological Empowerment as Mediator. BMC Nursing, 24, Article No. 682. [Google Scholar] [CrossRef] [PubMed]
[7] Michie, S., van Stralen, M.M. and West, R. (2011) The Behaviour Change Wheel: A New Method for Characterising and Designing Behaviour Change Interventions. Implementation Science, 6, Article No. 42. [Google Scholar] [CrossRef] [PubMed]
[8] 谢钰莹, 郭丽娜, 郭园丽, 等. COM-B模型在慢性病患者健康行为中的应用进展及启示[J]. 中国慢性病预防与控制, 2024, 32(11): 871-876.
[9] Wray, F., Clarke, D., Cruice, M., et al. (2021) Development of a Self-Management Intervention for Stroke Survivors with Aphasia Using Co-Production and Behaviour Change Theory: An Outline of Methods and Processes. PLOS ONE, 16, e0259103.
[10] Smith, R., Michalopoulou, M., Reid, H., Riches, S.P., Wango, Y.N., Kenworthy, Y., et al. (2022) Applying the Behaviour Change Wheel to Develop a Smartphone Application “Stay-Active” to Increase Physical Activity in Women with Gestational Diabetes. BMC Pregnancy and Childbirth, 22, Article No. 253. [Google Scholar] [CrossRef] [PubMed]
[11] Allison, A.L., Lorencatto, F., Michie, S. and Miodownik, M. (2022) Barriers and Enablers to Food Waste Recycling: A Mixed Methods Study Amongst UK Citizens. International Journal of Environmental Research and Public Health, 19, Article No. 2729. [Google Scholar] [CrossRef] [PubMed]
[12] Cane, J., O’Connor, D. and Michie, S. (2012) Validation of the Theoretical Domains Framework for Use in Behaviour Change and Implementation Research. Implementation Science, 7, Article No. 37. [Google Scholar] [CrossRef] [PubMed]
[13] Cowdell, F. and Dyson, J. (2019) How Is the Theoretical Domains Framework Applied to Developing Health Behaviour Interventions? A Systematic Search and Narrative Synthesis. BMC Public Health, 19, Article No. 1180. [Google Scholar] [CrossRef] [PubMed]
[14] Michie, S., Johnston, M., Abraham, C., et al. (2005) Making Psychological Theory Useful for Implementing Evidence Based Practice: A Consensus Approach. Quality and Safety in Health Care, 14, 26-33. [Google Scholar] [CrossRef] [PubMed]
[15] Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, N., et al. (2017) A Guide to Using the Theoretical Domains Framework of Behaviour Change to Investigate Implementation Problems. Implementation Science, 12, Article No. 77. [Google Scholar] [CrossRef] [PubMed]
[16] Mendívil-Pérez, M., Choperena, A., Salas, V., Chocarro-Haro, M. and Oroviogoicoechea, C. (2025) Interventions to Develop Clinical Judgment among Nurses: A Systematic Review with Narrative Synthesis. Nurse Education in Practice, 84, Article ID: 104300. [Google Scholar] [CrossRef] [PubMed]
[17] Gawthorne, J., McCloughen, A., Branch, J., McPhillips, O., Scott, D. and Curtis, K. (2025) Applying Behaviour Change Theory to Develop an Implementation Strategy for Nurse‐Initiated Protocols in the Emergency Department. Journal of Advanced Nursing, 82, 5194-5205. [Google Scholar] [CrossRef] 
[18] Whittal, A., Störk, S., Riegel, B. and Herber, O.R. (2020) Applying the COM-B Behaviour Model to Overcome Barriers to Heart Failure Self-Care: A Practical Application of a Conceptual Framework for the Development of Complex Interventions (ACHIEVE Study). European Journal of Cardiovascular Nursing, 20, 261-267. [Google Scholar] [CrossRef] [PubMed]
[19] Dyson, J., Lawton, R., Jackson, C., et al. (2011) Does the Use of a Theoretical Approach Tell Us More about Hand Hygiene Behaviour? The Barriers and Levers to Hand Hygiene. Journal of Infection Prevention, 12, 17-24.
[20] Qayum, A., Long, D., Harnischfeger, J., Cree, M., Waak, M. and Plummer, K. (2025) Barriers and Enablers in Nurses Implementing Light Sedation in Intubated and Ventilated Children: A Qualitative Exploratory Descriptive Study. Intensive and Critical Care Nursing, 89, Article ID: 104047. [Google Scholar] [CrossRef] [PubMed]
[21] Gu, Y., Tang, Y., Xue, Y., Wu, J. and Xie, J. (2025) Nurses’ Perspectives on Implementing Sleep Protection for Premature Infants in the Neonatal Intensive Care Unit: A Qualitative Study. BMC Health Services Research, 25, Article No. 347. [Google Scholar] [CrossRef] [PubMed]
[22] Wu, X., Bai, C., Tan, Y., Zhang, M., Wang, H., Liu, J., et al. (2025) Analysis of Facilitators and Barriers to Early Urinary Catheter Removal in Postoperative Patients by Spine Surgery Nurses: A Qualitative Study Based on the COM-B Model in China. BMC Nursing, 24, Article No. 451. [Google Scholar] [CrossRef] [PubMed]
[23] Nie, H., Yue, L., Peng, H., Zhou, J., Li, B. and Cao, Z. (2024) Nurses’ Engagement in Antimicrobial Stewardship and Its Influencing Factors: A Cross-Sectional Study. International Journal of Nursing Sciences, 11, 91-98. [Google Scholar] [CrossRef] [PubMed]
[24] Liao, L., Zhang, Y., He, X., Yang, X., Long, H., Tan, L., et al. (2025) Structural Equation Modeling for Influencing Factors with Quality Care Behavior among Nursing Assistants: A Cross-Sectional Study. BMC Nursing, 24, Article No. 280. [Google Scholar] [CrossRef] [PubMed]
[25] Wu, L., Liu, M., Huang, C., Yin, J., Zhou, H. and Hu, H. (2023) The Development of a Self-Management Evaluation Scale for Elderly Adults with Hypertension Based on the Capability, Opportunity, and Motivation-Behaviour (COM-B) Model. BMC Geriatrics, 23, Article No. 245. [Google Scholar] [CrossRef] [PubMed]
[26] Alex, J., Ramjan, L.M., Ferguson, C., Fishburn, M.L., Montayre, J. and Salamonson, Y. (2024) Development and Psychometric Evaluation of the Catheter Assessment, Management and Performance (CAMP) Scale for Nurses. Nurse Education in Practice, 80, 104122. [Google Scholar] [CrossRef] [PubMed]
[27] Zhang, W., Weng, Y., Zhang, X., Shen, H., Li, X., Liu, Y., et al. (2025) Shared Decision‐Making Behavior in Surgery among Early Breast Cancer Patients and Associated Factors Using COM‐B Model: A Latent Profile Analysis. Journal of Nursing Management, 2025, Article ID: 2347796. [Google Scholar] [CrossRef] [PubMed]
[28] Duan, L., Wang, T., Guo, Y., Fu, Z., Xu, T., Zhu, P., et al. (2025) Barriers and Facilitators to Shared Decision-Making for Patients with Cancer and Health Care Providers Based on the COM-B Model: A Systematic Review. BMC Medical Informatics and Decision Making, 25, Article No. 369. [Google Scholar] [CrossRef] 
[29] Dulay, E., Griffin, B., Trung, D., et al. (2025) Implementation of the “Countdown to Theatre” Approach to Bridge the Evidence-Practice Gap in Paediatric Preoperative Fasting: A Quality Improvement Initiative. Journal of Advanced Nursing, 82, 5405-5418.
[30] Advani, S.D., Winters, A., Turner, N.A., Smith, B.A., Seidelman, J., Schmader, K., et al. (2023) Using the COM-B Model to Identify Barriers to and Facilitators of Evidence-Based Nurse Urine-Culture Practices. Antimicrobial Stewardship & Healthcare Epidemiology, 3, e62. [Google Scholar] [CrossRef] [PubMed]
[31] Brierley, M.L., Smith, L.R., Bailey, D.P., Ojo, S.O., Hewson, D.J., Every, S.A., et al. (2022) Evaluating a Multi-Component Intervention to Reduce and Break up Office Workers’ Sitting with Sit-Stand Desks Using the APEASE Criteria. BMC Public Health, 22, Article No. 458. [Google Scholar] [CrossRef] [PubMed]
[32] Combes, S., Forbes, G., Gillett, K., Norton, C. and Nicholson, C.J. (2021) Development of a Theory-Based Intervention to Increase Cognitively Able Frail Elders’ Engagement with Advance Care Planning Using the Behaviour Change Wheel. BMC Health Services Research, 21, Article No. 712. [Google Scholar] [CrossRef] [PubMed]
[33] Gallant, A.J., Steenbeek, A., Halperin, S.A., Parsons Leigh, J. and Curran, J.A. (2024) Operationalizing the Behaviour Change Wheel and APEASE Criteria to Co-Develop Recommendations with Stakeholders to Address Barriers to School-Based Immunization Programs. Vaccine, 42, Article ID: 126226. [Google Scholar] [CrossRef] [PubMed]
[34] Ng, W., Beales, D., Gucciardi, D.F. and Slater, H. (2023) Applying the Behavioural Change Wheel to Guide the Implementation of a Biopsychosocial Approach to Musculoskeletal Pain Care. Frontiers in Pain Research (Lausanne), 4, Article ID: 1169178. [Google Scholar] [CrossRef] [PubMed]
[35] Keyworth, C., Epton, T., Goldthorpe, J., Calam, R. and Armitage, C.J. (2020) Acceptability, Reliability, and Validity of a Brief Measure of Capabilities, Opportunities, and Motivations (“COM‐B”). British Journal of Health Psychology, 25, 474-501. [Google Scholar] [CrossRef] [PubMed]

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