Qom University of Medical Sciences Journal

Introduction
Heart Failure (HF) is a chronic disease that has affected more than 26 million people worldwide with growing prevalence rate and poor prognosis. This disease causes a decrease in physical strength, disruption in personal and social relationships, declined ability to perform job duties, economic problems, and increased medical costs, all of which affect the quality of life (QoL). Therefore, taking measures for disease control and treatment and improvement of their QoL is necessary. One of the important nursing models, which is based on people’s QoL and self-care abilities and needs is Orem’s self-care model. In this model, three types of nursing system have been designed: wholly compensatory system, partly compensatory system, supportive-educative system. Based on the wholly compensatory system, the nurse performs all patient care to compensate the patient’s self-care deficits. In the partly compensatory system, the nurse and the patient participate together in meeting the self-care needs. When the patient can meet their own needs but cannot do it without support, the supportive-educative system is used. This system helps patients to make decisions, control behaviors, and acquire knowledge and skills. In this case, the nurse has an educational and supportive role.
Self-care leads to disease management, increased independence, satisfaction, and maintenance of respect and dignity in the family and society. In this field, the Orem model has attracted the attention of many researchers in the clinical field, and so far, many studies have been conducted in this field. For example, in Shojaei’s study (2006), the QoL of HF patients based on Orem’s model was reported good, but in Asadi’s study (2019), it was at a moderate level. The conducted studies on the effect of self-care based on Orem’s self-care model on the QoL of HF are descriptive or interventional. Conducting a review study in this field can help summarize the results of these studies. Therefore, this study aims to review various studies used Orem’s self-care model to assess the QoL of HF patients.
Method
 This is a systematic review. A search was first conducted from October to December 2021 in Science Direct, MagIran, Irandoc, IranMedex, Scientific Information Database (SID), Scopus, Cochran, Google Scholar, and PubMed databases for the studies using the keywords Orem, self-care, heart failure, QoL based on MeSH terms in Persian and English with “AND” and “OR” operators without time limit. Initial search yielded 865,837 articles related to self-care and QoL of HF patients. By removing duplicates, articles with no accessible full text, letters to the editor, and short reports, 12 eligible articles were finally selected for the review. To extract the data, a data extraction form was used with following sections: Authors’ name, study year, study objective, study design, sample size, data collection method, and results. After completing this form, the data were analyzed, summarized and finally reported.
Results
In most of the studies, the QoL of HF patients using Orem’s self-care model was at a moderate level. in all experimental and quasi-experimental studies, the QoL of HF patients improved after receiving the self-care educational program. The QoL of patients had a significant positive relationship with age, gender, number of children, level of education, occupation, living in an urban area, ejection fraction, length of stay in the hospital, recreational activities, self-care behaviors, self-care training, management, self-confidence, better functional capacity, and underlying diseases; and a significant negative relationship with comorbidity, depression, anxiety and personality type D.
Discussion
The findings of studies showed the moderate QoL of HF patients. Their QoL improved after receiving education based on Orem’s self-care model. Since in this model, all the factors affecting the QoL (diet and medication, daily weighing, regular exercise, monitoring symptoms and signs of disease exacerbation, searching and deciding on appropriate treatment measures) are emphasized and engage the patient in self-care, their QoL increases in all dimensions.
Orem’s self-care model is compatible with different cultures and is an simple, efficient and reliable model that can used in different countries for improving various aspects of the QoL of patients with HF.
Ethical Considerations
Compliance with ethical guidelines
This study was approval by the ethics committee of Kashan University of Medical Sciences (Code: IR.KAUMS.NUHEPM.REC.1401.032).

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.
Authors contributions
All authors equally contributed to preparing this article.
Conflicts of interest
 The authors declare no conflict of interest.
Acknowledgements
We thank and appreciate all the authors whose articles were used for this research.