{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:52:43Z","timestamp":1791075163567,"version":"4.1.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nurs"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Patients with permanent pacemakers frequently demonstrate insufficient knowledge and inadequate self-care behaviours, which increase the risk of avoidable post-implantation complications. Structured, theory-informed empowerment protocols may improve these outcomes, yet robust evidence from low- and middle-income countries remains limited. Grounded in Bandura\u2019s self-efficacy theory and a patient-empowerment model, this study evaluated the effect of a nurse-led empowerment protocol on knowledge, practical skills, and self-care behaviours among patients with permanent pacemakers.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A non-equivalent control-group, pretest\u2013posttest quasi-experimental design was used and reported in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement. Seventy adults with newly implanted permanent pacemakers were recruited from Tanta University Hospitals, Egypt, between December 2025 and April 2026. Because the two arms were recruited in consecutive calendar periods to prevent educational contamination, allocation was non-random and group membership is confounded with time period. The control group (\n n<\/jats:italic>\n \u2009=\u200935) received routine hospital care; the study group (\n n<\/jats:italic>\n \u2009=\u200935) additionally received a structured empowerment protocol (four individual sessions of 30\u201345\u00a0min each, using illustrated Arabic booklets, demonstration and return demonstration, followed by weekly telephone reinforcement during the first month). Three co-primary outcomes were assessed at baseline, immediately post-intervention, and at one-month follow-up: knowledge (Pacemaker-Related Knowledge Questionnaire, 0\u201320), practice competence (Observational Checklist, 0\u201350), and self-care behaviour (Self-Care Behaviours Scale, 0\u201320). Data were analysed using repeated-measures ANOVA (group \u00d7 time) with Greenhouse\u2013Geisser correction and independent and paired t-tests; a family-wise threshold of \u03b1\u2009=\u20090.017 (0.05\/3) was applied across the three co-primary group \u00d7 time tests. Between-group effect sizes and 95% confidence intervals (CIs) were computed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The study group improved significantly more than the control group on all three co-primary outcomes. Mean knowledge scores rose from 6.51\u2009\u00b1\u20092.45 to 15.31\u2009\u00b1\u20093.46 post-intervention (control: 5.57\u2009\u00b1\u20092.47 to 7.46\u2009\u00b1\u20095.60; group \u00d7 time F(1.43, 97.38)\u2009=\u2009148.09,\n p<\/jats:italic>\n \u2009<\u20090.001, \u03b7\u00b2\n p<\/jats:italic>\n \u2009=\u20090.685; between-group post-intervention difference 7.85 points, 95% CI 5.67\u201310.03, Cohen\u2019s d\u2009=\u20091.69). Practice competence improved from 16.29\u2009\u00b1\u20092.87 to 41.17\u2009\u00b1\u200910.00 in the study group (control: 14.91\u2009\u00b1\u20093.33 to 18.54\u2009\u00b1\u200912.21; F(1.59, 108.12)\u2009=\u2009120.34,\n p<\/jats:italic>\n \u2009<\u20090.001, \u03b7\u00b2\n p<\/jats:italic>\n \u2009=\u20090.639; difference 22.63, 95% CI 17.40\u201327.86, d\u2009=\u20092.03). Self-care behaviour scores increased from 13.63\u2009\u00b1\u20093.11 to 19.00\u2009\u00b1\u20093.23 in the study group (control: 12.86\u2009\u00b1\u20092.30 to 15.00\u2009\u00b1\u20093.10; F(2, 136)\u2009=\u200949.85,\n p<\/jats:italic>\n \u2009<\u20090.001, \u03b7\u00b2\n p<\/jats:italic>\n \u2009=\u20090.423; difference 4.00, 95% CI 2.52\u20135.48, d\u2009=\u20091.26). All three interactions remained significant at the family-wise threshold, and the groups did not differ significantly on any recorded baseline characteristic. Gains were partially sustained at one-month follow-up.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this non-randomised study, participants who received a structured, nurse-led empowerment protocol showed substantial and partially sustained gains in knowledge, practical skills, and self-care behaviours, whereas the corresponding gains observed under routine hospital care alone were minimal. Because the two groups were recruited in consecutive calendar periods rather than randomised concurrently, and because outcome assessment was unblinded, these results are best interpreted as an association observed under a quasi-experimental design rather than as causal evidence equivalent to that of a randomised controlled trial. They nonetheless provide a reasonable basis for evaluating systematic, interactive empowerment programmes\u2014incorporating individualised education and scheduled reinforcement\u2014as an addition to routine post-implantation nursing care, and for testing them in randomised, attention-controlled trials with blinded assessment and longer follow-up.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n ClinicalTrials.gov, NCT07743346. Registered on 26 July 2026. Retrospectively registered. Available at:\n https:\/\/clinicaltrials.gov\/study\/NCT07743346<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s12912-026-05368-3","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T11:05:41Z","timestamp":1791025541000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of a structured nurse-led empowerment protocol on knowledge, practical skills, and self-care behaviours among patients with permanent pacemakers: a quasi-experimental study"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5379-3243","authenticated-orcid":false,"given":"Walaa Nady Sayed","family":"Kamel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2576-1619","authenticated-orcid":false,"given":"Aml Ramadan Abdelgalil","family":"Assaf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2459-6860","authenticated-orcid":false,"given":"Ahmed Mostafa","family":"Shehata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5963-4759","authenticated-orcid":false,"given":"Nahla Mohamed Mahmoud","family":"Afify","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,3]]},"reference":[{"key":"5368_CR1","first-page":"389","volume-title":"Critical care nursing: diagnosis and management","author":"L Urden","year":"2023","unstructured":"Urden L, Stacy K, Lough M, Sanchez K. 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Egypt J Nurs Health Sci. 2021;2(2):82\u2013110. https:\/\/doi.org\/10.21608\/ejnhs.2021.173678.","journal-title":"Egypt J Nurs Health Sci"}],"container-title":["BMC Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12912-026-05368-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12912-026-05368-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12912-026-05368-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:04:09Z","timestamp":1791072249000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12912-026-05368-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,3]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5368"],"URL":"https:\/\/doi.org\/10.1186\/s12912-026-05368-3","relation":{},"ISSN":["1472-6955"],"issn-type":[{"value":"1472-6955","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,3]]},"assertion":[{"value":"10 July 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the Scientific Research Ethics Committee, Faculty of Nursing, Tanta University (approval code 817-10-2025). All participants provided written informed consent. The study was conducted in accordance with the Declaration of Helsinki. The study is registered on ClinicalTrials.gov (NCT07743346; registered 26 July 2026, retrospectively registered; available at\n \n ).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable (the manuscript contains no individual person\u2019s data in any form).","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"917"}}