Nurses Knowledge regarding Permanent Pacemaker Care for Adult Patients with Cardiac Rhythm Disorder

with statistical test chi-square with p < 0.05 for categorical variable. Results: According to this study, most of the participants (77.3%) were women aged 21 to 30 years, unmarried (57.3%), and had completed their diploma (50.8%). The study found that 66.5% of nurses were with satisfactory level of knowledge in nursing care for adult patients with pacemakers, while 33.5% had an unsatisfactory level of knowledge. The knowledge of nurses who held a BSN or a POST RN quali�cation was signi�cantly higher than those who only held a diploma with a p-value of 0.001. Conclusions: Majority of the participants possessed satisfactory knowledge regarding the care of patients with permanent pacemakers. The study also revealed a signi�cant association between the level of education of nurses and their knowledge scores. The study concludes that consistency in the provision of education is necessary for the enhancement of nurses' knowledge, expertise, and competencies in providing care to patients with permanent pacemakers.

permanent pacemakers, which replace sluggish or irregular beats with normal beats. Bradycardia can cause decreased tissue perfusion, dyspnea, and congestive heart failure. When an arrhythmia is severe, it may require immediate treatment to restore regular rhythm [4]. According to the World Health Organization (WHO), cardiovascular disease caused an estimated 17.9 million deaths worldwide in 2016 [5]. In Malaysia, statistical data from 2012 revealed that 295.8% of deaths per 100,000 populations were caused by cardiovascular disease. It is also estimated that sudden cardiac death causes approximately 450,000 deaths worldwide [6]. Recent ndings have shown that cardiovascular disease (CVD) is The effective and e cient functioning of the heart relies entirely on the precise timing of its beats. Without a strong and steady heartbeat, blood cannot ow to where it needs to go, and the heart's contractions will be weakened. Any interruption in the heart's electrical impulses or issues leads to heart block and arrhythmia. Thus, reciprocal are necessary to ensure the cardiac rhythm properly [1]. The heart's conducting system is a specialized network of electrical pathways [2].  Ali et al.,[14]. The assessment of knowledge involved 15 questions, where each correct response received a point value of one and each incorrect response received zero points. The knowledge level was categorized into two groups: satisfactory and unsatisfactory, based on a total score of 15. Satisfactory knowledge was de ned as a score between 9 and 15, indicating a mean of over 60%. Unsatisfactory knowledge, on the other hand, was characterized by a score below 9, indicating a mean of less than 60%. Each available nurse was given 30 minutes to complete the questionnaire. Data analysis was performed using the statistical package for social science (SPSS) version 21.0, and the researchers used frequency distribution tables and percentages for analysis. The Kolmogorov-Smirnov test was used for the testing normality of data distribution, and the chi-square test was used to test for statistical signi cance with a p-value of less than 0.05 for categorical variables.

M E T H O D S
the primary cause of death worldwide, with approximately 80% to 86% of fatalities occurring in low-and middleincome nations. Most of the South Asian countries, such as Pakistan, India, Bangladesh, Sri Lanka, and Nepal, which make up more than a quarter of low and middle-income countries, have a higher risk of coronary heart disease (CHD) compared to other regions. In Punjab, Pakistan, CVDs are the leading cardiac issue affecting 17.5% of the population studied [7]. Electric stimulation of the heart has become a popular method for treating bradycardia or highgrade atrioventricular block. The use of pacemakers has increased signi cantly in recent years due to technological advancements and the expanding range of medical conditions they can be used to treat. Approximately 1.25 million permanent pacemakers are implanted worldwide every year [8]. At present, heart rhythm irregularities can be addressed by using a permanent pacemaker (PPM), helps the heart when the heart rate decrease than 60 beats per minute. The PPM works as an arti cial sino-atrial node that regulates the electrical activity of the heart and elevates the heart rate more than 60 beats per minute [9].
To treat heart rhythm disturbances that result in a slower heartbeat, pacemakers are employed, including single and dual-chamber types. If the rate of heart falls lower than 60 beats per minute (sometimes less than 30-40 beats per minute) and insu cient tissue oxygenation results, a p a c e m a ke r i s i m p l a n te d e i t h e r i n t h e a t r i a l o r atrioventricular sinus node to correct abnormal heart rhythm and address tissue hypoxia. Patients who undergo this procedure and receive a pacemaker can live a normal life [10]. Nurses have to play a vital role in the care of patients with PPM by keeping pacemaker knowledge up to date by the help of continuous education and training sessions to ensure comprehensive care [11]. Pacemaker management knowledge is complicated, critical, as well as it is a key factor in verifying that patients are fully informed about the pacemaker [12]. Nurses play an important role in the education of the patients and family members prior to surgery, liaising with the multidisciplinary team [13]. It is important to evaluate the knowledge of patients and caregivers regarding the pacemaker, as it becomes an essential part of the patient's life. This is necessary to avoid any potential complications and to provide timely treatment. Nurses play a central role in managing pacemaker patients and need to keep themselves updated on the latest information and challenges. However, a very limited research is done on the nurses' knowledge regarding management of the pacemaker in the local context. Therefore, this study was conducted to assess the basic knowledge of nurses in managing patients with pacemaker implantation, with the aim of providing ongoing education on updated pacemaker information.

R E S U L T S
This study was carried out over a 185 nurses working in the PIC; the main purpose of the study was to assess the knowledge level and nd the knowledge among a nurses regarding nursing care of adult patients with pacemaker. This chapter nding was analyzed by using frequency table and chi square test because most variables were descriptive and categorical. The study found that the 185 participating were female nurses (100%) and aged between 21-30 years (77.3%). There were no male nurses in the study because there were none working in the PIC setting.
Regarding marital status, 57.3% of nurses were single and 42.7% were married. In terms of job experience, 65.4% of nurses had 1-3 years of experience, 25.4% had 4-6 years, and 9.2% had 7-9 years. Educational levels of nurses were also assessed, with 50.8% holding a diploma, 21.6% a Post RN degree, and 27.6% a BSN degree. Only 1.1% of nurses had received any training workshop regarding the nursing care of patients with pacemaker. In terms of knowledge assessment, 33.5% of nurses were with unsatisfactory knowledge (scoring below 9 out of 15), while 66.5% had satisfactory knowledge (scoring 9-15 out of 15). This indicates that the majority of the participating nurses were young, female, with relatively less experience and had diploma-level education as shown in the Table 1.

D I S C U S S I O N
To ensure comprehensive care for patients with pacemaker (PPM), it is necessary for nurses to continuously gain the latest knowledge on pacemaker management through training and education. Role of the nurses is very crucial in providing education to patients and their families, and liaising with the multidisciplinary team. Our study found that most of the nurses who participated were young, female, single, with 1-3 years of job experience, and diploma holders.  Analyzed by frequency (n) and Percentage (%) This results stated that knowledge of nurses regarding n u r s i n g c a r e o f a d u l t p a t i e n t w i t h p a c e m a ke r, unsatisfactory knowledge (<9) 62 (33.5%) and satisfactory knowledge (9-15) 123 (66.5%). The mean (X) was 9.51 and standard deviation (SD) was 1.78. It means that most of the study participants full between satisfactory knowledge score 9-15 as shown in Table 2.  . This basically indicated that in our study most of the participants were score satisfactory as we compare our study nding to other studies. The reason for this was that knowledge gap among nurses regarding nursing care of adult patients with pacemaker, as per educational level satisfactory knowledge of BSN was 90%, POST RN satisfactory knowledge 64% and satisfactory knowledge of diploma holders was 57%. There was signi cant gap between the education level and knowledge level of the study participants with p< 0.05. According to this study educational level is directly correlated with the knowledge level of the study participants that why BSN and POST RN score more than diploma holders. Our study ndings were supported by Elgazzar, additionally the study of Angelidou stated that there was a highly signi cant statistical difference between the means of the studied subjects' knowledge and practice scores based on their educational level with a p less than 0.05 [19,20]. Furthermore, another study found an extremely statistically signi cant relationship between nurses' knowledge and level of education (p=0.0001) [17].
The study found that the majority nurses were with satisfactory knowledge of nursing care for adult patients with pacemakers. Furthermore relationship between education level and patient care highlights the signi cance of advanced education in nursing. Improving nurses' knowledge in this domain can have signi cant implications for patient safety, as well as the overall quality of care provided. By addressing potential de ciencies in knowledge, healthcare institutions can strive towards standardized and evidence-based practices in permanent pacemaker care.