Nursing Guideline Helps Heart Device Patients Accept Implants and Regain Confidence

For the millions of people worldwide who live with an implantable cardioverter defibrillator, the device inside their chest is both a guardian and a burden. The small pulse generator, implanted below the collarbone and wired into the heart, continuously monitors the cardiac rhythm and delivers an electrical shock when it detects a life-threatening ventricular arrhythmia. That shock can be the difference between life and death, yet the psychological weight of carrying a device that may fire at any moment is considerable. A new quasi-experimental study published in BMC Nursing suggests that a structured, evidence-based nursing intervention delivered before and shortly after implantation can meaningfully improve how patients accept the device and how confident they feel in managing life with it.

The research, conducted by Arnel Boke Kilicli of Ankara Bilkent City Hospital, Imatullah Akyar of Hacettepe University, and Kim Litwack of the University of Wisconsin-Milwaukee, set out to address a persistent gap in cardiac care. Although ICDs are globally utilized to prevent sudden cardiac death, many recipients experience psychological challenges and difficulty adapting to the device. Low self-efficacy, the belief in one’s own capacity to handle device-related situations, can erode a patient’s confidence in managing ICD-related challenges and adjusting to daily life. The team aimed to develop an evidence-based ICD nursing guideline and then evaluate its effects on self-efficacy and device acceptance among patients in the pre- and early post-implantation periods.

The study enrolled 60 ICD candidates, divided evenly into a control group of 30 patients and an intervention group of 30 patients, recruited between August 16, 2021, and November 17, 2022. The design was quasi-experimental: the control group was recruited first and received routine care, after which the intervention group received guideline-based nursing care spanning both the pre-implantation preparation phase and the early weeks after the device was placed. This sequential approach allowed the researchers to compare outcomes between patients who received standard support and those who received a standardized, evidence-driven program of nursing care and education.

The methodological backbone of the study is as interesting as its results. The researchers built their nursing guideline using the ADAPTE methodology, a rigorous framework for adapting existing high-quality clinical guidelines to a new context, and they implemented the resulting protocol through the Johns Hopkins Nursing Evidence-Based Practice Model, a widely used tool that translates research evidence into bedside practice. In practical terms, this meant assembling the best available evidence on ICD care, distilling it into actionable nursing recommendations, and pairing the guideline with supporting tools that nurses could use consistently with every patient rather than relying on individual habits or institutional tradition.

To measure the intervention’s impact, the team deployed a battery of validated instruments. Device acceptance was assessed with the Florida Patient Acceptance Survey, while self-efficacy was captured with the Self-Efficacy Expectations After Implantable Cardioverter Defibrillator Implantation scale, abbreviated SE-ICD. Outcome expectations were measured with the companion OE-ICD instrument, satisfaction with nursing care was evaluated using the Newcastle Satisfaction with Nursing Scale, and the analysis accounted for clinical characteristics such as New York Heart Association functional class and left ventricular ejection fraction. Data normality was tested with the Shapiro-Wilk test, and comparisons were made using Fisher’s exact test, Yates’ corrected chi-square test, Student’s t-test, and the Mann-Whitney U test, depending on the distribution and type of each variable.

The results were striking. On both Day 7 and Day 30 after implantation, device acceptance and ICD-related self-efficacy were significantly higher in the intervention group, while device-related distress and body image concerns were significantly lower, with p-values below 0.001. By Day 30, ICD-related outcome expectations, essentially the patients’ beliefs about what life with the device would look like, were also significantly higher in the guideline-based care group. In addition, patients who received the structured intervention reported higher satisfaction with nursing care at the time of discharge. In a field where psychological outcomes often lag behind technical success, these consistent differences across multiple time points and multiple measures carry real weight.

Why should a nursing protocol produce such effects? The answer likely lies in what standardized, evidence-based care replaces. Patients awaiting an ICD frequently face a barrage of anxieties: fear of shocks, uncertainty about physical activity, concerns about the visible bulge of the generator, and doubts about their ability to cope if the device fires. When education and emotional support depend on which nurse happens to be on shift, the information patients receive can be inconsistent, incomplete, or delivered at the wrong moment. A guideline-based intervention ensures that every patient hears the same core messages before implantation, has misconceptions addressed early, and receives structured follow-up during the vulnerable first month when adjustment trajectories are formed.

The study’s design does come with caveats that the authors and readers should keep in view. As a quasi-experimental study with sequential recruitment rather than random allocation, it cannot fully exclude the influence of temporal factors, such as changes in hospital staffing or patient mix over the recruitment period. The sample of 60 patients, while adequate for detecting the observed differences, is modest. The trial was retrospectively registered on ClinicalTrials.gov as NCT07449559 on March 3, 2026, because the project began as a practice-based evidence implementation effort, a detail the authors disclose transparently. Even so, the magnitude and consistency of the outcome differences, all at p < 0.001, suggest an effect that is unlikely to be explained by chance alone.

The broader implications extend well beyond a single hospital in Ankara. ICD implantation rates continue to rise globally as populations age and indications expand, which means the population of patients grappling with device-related distress is growing in parallel. Psychological maladjustment after implantation is associated with poorer quality of life and can undermine the very benefits the device is meant to provide, since anxious patients may avoid activity or fail to engage with follow-up care. If a structured nursing guideline, built from existing evidence with established adaptation frameworks, can reliably lift acceptance and self-efficacy, it offers a scalable and relatively low-cost complement to the procedural and pharmacological pillars of arrhythmia care.

The authors conclude that a guideline-based nursing intervention may support more standardized nursing care and patient education across the pre- and early post-implantation care continuum. The study received no specific grant from any funding agency, and the authors declare no competing interests. Ethics approval came from Hacettepe University’s Non-Interventional Clinical Research Ethics Committee, and all participants gave informed consent. For nurses, cardiologists, and hospital administrators, the message is concrete: investing in evidence-based nursing protocols for ICD patients is not a soft addition to care but a measurable driver of psychological recovery. For patients, it means that the weeks surrounding implantation, often dominated by fear and uncertainty, could increasingly be guided by care that is as systematic and evidence-grounded as the device itself.

Subject of Research: Evidence-based nursing intervention for device acceptance and self-efficacy in implantable cardioverter defibrillator patients

Article Title: Evidence-based nursing intervention guided by a nursing guideline is associated with higher device acceptance and self-efficacy in patients with implantable cardioverter defibrillator: a quasi-experimental study

Article References: Kilicli, A. B., Akyar, I., & Litwack, K. (2026). Evidence-based nursing intervention guided by a nursing guideline is associated with higher device acceptance and self-efficacy in patients with implantable cardioverter defibrillator: a quasi-experimental study. BMC Nursing. https://doi.org/10.1186/s12912-026-05335-y

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05335-y

Keywords: implantable cardioverter defibrillator, evidence-based nursing, nursing guideline, device acceptance, self-efficacy, patient education, quasi-experimental study, ADAPTE methodology, Johns Hopkins model, device-related distress, cardiac care, BMC Nursing