Introduction: Permanent pacemaker implantation (PPI) is linked to a marked decline in mortality rates. The use of implantable cardiovascular electronic devices has significantly increased these devices have been widely employed in the past twenty-years to treat potentially lethal arrhythmias and non-arrhythmic disorder e.g. chronotropic incompetence and heart failure. Annually, around 1.25 million pacemakers are implanted globally. Data from the cardio- electrophysiology unit at the Main University Hospital indicated that approximately 200 patients underwent pacemaker implantation in 2018 alone. Nurses play a vital role in understanding patients' perspectives on QOL to enhance the care they provide and, ultimately, improve patient outcomes. Their focus on QOL is essential, as it can influence treatment decisions, including prescription choices, adjustments to treatment plans, and decisions regarding the continuation or cessation of therapies. For patients with chronic conditions, such as those requiring permanent pacemaker implantation (PPI), assessing QOL is crucial for nursing managers. This assessment aids in the efficient allocation of healthcare resources and the resolution of patient care challenges. As integral members of the healthcare team, nurses possess the chance to positively influence patients' QOL through targeted nursing interventions. To do so effectively, it is important for nurses to first evaluate the QOL of patients with PPI. Aim of the study: This study aimed to evaluate the impact of learning instructional program on QOL among patients with permanent pacemaker device. This was achieved by the following objectives: 1. Appraise patients' knowledge and practices concerning permanent pacemaker device. 2. Assess QOL among patients with permanent pacemaker device. 3. Develop and implement learning instructional program for patient’s permanent pacemaker device. 4. Evaluate effect of learning instructional program on QOL among patients with permanent pacemaker device. Hypothesis This study achieved the following hypothesis: H 1 : Patients' post-learning knowledge scores will be significantly greater than their pre- learning knowledge scores. H 2 : Patients' post-learning practice scores will exceed their pre-learning practice scores. H 3 : Learning instructional intervention will have a positive effect on enhancing the QOL of patients. 1 Research Design: A quasi-experimental research design was utilized to conduct the study with a pre-posttest was implemented. Study setting: The research was performed at the Cardiac Intensive Care Unit, Cardiology Department, and outpatient clinics of Zagazig University Hospitals. Study Sample: A purposive sample of (50) patients with permanent pacemaker device. Patients with mental disorders, as well as those unable to communicate were excluded from the study. Tools for data collection: Three instruments were utilized to gather data: Instrument I – An interview questionnaire, designed by the researchers in Arabic, was created after reviewing relevant literature (Sikora et al., 2021; Magnusson & Liv, 2018). The questionnaire was divided into three sections Section 1 – Socio-demographic Information Section 2 – Clinical Data Section 3 – Patients' Knowledge Tool II- Observational Checklist: It was be adapted from Yossif & Abd- El-aal, (2017) and modified by the researcher to evaluate patients' practices regarding permanent pacemaker device totally 28 steps. Tool III: Euro QOL - 5Dimentions (EQ-5D) structure interview schedule: This tool was established by Euro-QOL-group (1990) to appraise QOL and was adapted by Euro-QOL- group (2005). It included the two elements listed below: A- The EQ-5D-5-Level structure interview schedule: It include the following five dimensions: 1- Mobility (the ability of the patient to move in comparison with before the surgery). 2- Self-care (the ability of the patient to wash or dress him or herself) 3- Usual activities 4- Pain/discomfort (degree of pain or discomfort feeling) 5- Anxiety or Depression (degree of anxiety or depression) B - Visual analogue scale (VAS) Pilot study: A pilot study was conducted with 10% of the total patient sample to evaluate the clarity, visibility, and time needed to complete the tools. Since no changes were made based on the pilot study, these patients were subsequently included in the main study sample. Field work  The study was conducted in four phases: preparation, planning, implementation, and evaluation. These phases took place from May 2024 to October 2024.  Researchers visited the designated setting three times a week (Saturday, Sunday, and Thursday) from 9:00 am to 1:00 pm. The data collection process for each session took approximately 30-45 minutes, and the overall data collection span lasted about six months. Assessment phase: The researcher started to recruit participants after reviewing their eligibility. Separate interviews were conducted using the data collection form with 1 individuals who gave their consent. The data collected served as a preliminary assessment that the researcher sed to shape the learning instructional program. Planning phase: The researchers developed a learning instructional program to educate patients with permanent pacemaker device to improve their knowledge, practice and QOL results. Implementation phase: The researchers conducted individual meetings with the patients and implemented the foundational learning program across ten-session intervals, with each session lasting 30 to 45 minutes. Evaluation phase: Every patient in the study had 2 evaluations utilizing identical data- gathering tools. This was conducted at the time of recruiting (pre-test) and after 3 months of instructional learning as a post-test. Results: study outcomes indicated that the majority of the participants were male (86%), with ages ranging from 43-68 years. Additionally, 64%of the patients had a history of myocardial infarction. Results also revealed statistically significant enhancement inpatients' knowledge, practices, and overall QOL post-intervention phase. Conclusion: The study revealed extremely significant variations in patients' knowledge, practice and QOL between pre- and post-assessments three months following the implementation of learning instructions and permanent pacemaker implantation. Recommendation: The following recommendations are proposed for patient care: • The educational program should be integrated as a key element in the comprehensive care plan for patients receiving pacemakers. • A periodically updated, color-illustrated booklet containing detailed post-implantation instructions should be provided to all patients undergoing permanent pacemaker implantation. Regarding future research: • The study should be replicated with a larger sample size and over a longer duration to validate the findings of the current research. • Further studies should be conducted on the long-term effects of the educational program on patient outcomes.