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

Implantable cardioverter defibrillators (ICDs) are globally utilized devices to prevent sudden cardiac death by detecting and terminating life-threatening ventricular arrhythmias. Despite their life-saving benefits, many patients experience psychological challenges and difficulties adapting to the device. Low self-efficacy may reduce patients’ confidence in managing ICD-related challenges and adapting to life with the device. This study aimed to develop an evidence-based ICD nursing guideline and to evaluate patient outcomes associated with a guideline-based nursing intervention, particularly self-efficacy and device acceptance, among ICD candidates during the pre- and early post-implantation periods. A quasi-experimental study was conducted with 60 ICD candidates (30 in the control group, 30 in the intervention group) recruited between August 16, 2021, and November 17, 2022. An evidence-based ICD nursing guideline, together with supporting tools, was developed using the ADAPTE methodology and implemented using the Johns Hopkins Nursing Evidence-Based Practice Model. The control group was recruited first and received routine care, followed by the intervention group, which received guideline-based nursing care during the pre- and post-implantation periods. Data normality was assessed using the Shapiro–Wilk test. Depending on data distribution and variable type, Fisher’s exact test, Yates’ corrected chi-square test, Student’s t-test, and the Mann–Whitney U test were used for statistical comparisons. Significant between-group differences were observed in several patient outcomes. On Days 7 and 30, device acceptance and ICD-related self-efficacy were higher in the intervention group, while device-related distress and body image concerns were lower ( p < 0.001). ICD-related outcome expectations were significantly higher by Day 30 ( p < 0.001). Additionally, the intervention group reported higher satisfaction with nursing care at discharge ( p < 0.001). These findings suggest that a guideline-based nursing intervention may support more standardized nursing care and patient education during the pre- and early post-implantation care continuum. ClinicalTrials.gov, NCT07449559. Retrospectively registered on 3 March 2026. As the study was initially conducted as a practice-based evidence implementation project, trial registration was completed retrospectively before manuscript submission.