Objective: To explore the status of strengths use, social support, and surrogate decision-making self-efficacy among families of patients with severe abdominal infection, and analyze their association. Methods: With convenient sampling method, a total of 196 families were investigated with Surrogate Decision-Making Self-Efficacy Scale, Strengths Use Scale, and Social Support Rate Scale. Results: The average score of Surrogate Decision-Making Self-Efficacy Scale, Strengths Use Scale, Social Support Scale were 13.56±3.61, 41.78±5.61, 35.50±5.86, respectively. Social support score was positively correlated with the score of strengths use and surrogate decision-making self-efficacy, and strengths use score had a positive correlation with surrogate decision-making self-efficacy score (P<0.05). The score of social support had a directly positive effect on the score of surrogate decision-making self-efficacy, and strengths use was a mediator between social support and surrogate decision-making self-efficacy, the intermediary effect was 0.173, which accounted for 22.91% of the total effect. Conclusion: Social support and strengths use are closely related to surrogate decision-making self-efficacy. Clinical managers should pay attention to surrogate decision-making self-efficacy, and guide them to correctly apply their strengths, so as to maximize the benefits of patients.