This scoping review was based on the approach described by Arksey and O’Malley (29) and further developed by Levac, Colquhoun (30). This systematic review method is recommended by the Joanna Briggs Institute as it improves the review’s rigor and clarity (31). This procedure entails a 5-step process that includes the following steps: (1) establishing and aligning the objective(s) and questions(s); (2) developing and matching the inclusion criteria with the objective(s) and question(s); (3) outlining the planned approach from evidence searching, selecting data extracting, to presenting the evidence; (4) summarizing the evidence as to the review’s purpose, (5) drawing a conclusion, and noting any implications that the results have. This scoping review was registered on Open Science Framework, with registration DOI number https://doi.org/10.17605/OSF.IO/JK7EB. The PRISMA reporting guidelines was followed to provide guidance for the reporting of this scoping review by evaluating the effects of interventions (32). This scoping review was structured and organized according to the PRISMA checklist, ensuring that all relevant components were systematically addressed. Following these established guidelines enhances the clarity and completeness of the review, providing a robust foundation for the findings and conclusions. Adhering to PRISMA reflects a commitment to maintaining high standards in research methodology.

The question “What is the existing literature on the use of community-based education programs for older adults to support empathy, emotional intelligence, and caring behaviors development among nursing students?” was acted as a starting point to provide search terms. According to the PICO framework for formulating clinical questions, the queries include four aspects: Patient-Problem (P), Intervention (I), Comparison (C) and Outcome (O). In this regard, Population, Intervention, Comparators, Outcomes, Study Design (PICOS) criteria were used for this study: population (undergraduate nursing students and medical students), intervention (community-based education and geriatric curriculum innovation) and outcome (empathy, emotional intelligence, caring behavior).

Following the PCC framework (Population, Concept, and Context) (33), studies were included if they were: (1) English language articles that were published in the past 10 years, from 2013 to 2024; (2) primary research articles about community-based education, and examined the changes in the undergraduate nursing students’ empathy, emotional intelligence, and caring behaviors (dissertations, peer-reviewed research, evidence-based practice guidelines); (3) primary research that looking into the effectiveness of the older adults’ education for improving nursing students’ capabilities or competencies; and (4) articles related to community-based medical education. The search also included gray literature, such as conference reports, graduate thesis, and so on.

The exclusion criteria were: (1) studies that did not answer the main research question or meet the main objective of this scoping review (for instance, the studies that focused on the effects on older people rather than on nursing students); (2) an inappropriate study design (for example, observational studies); (3) studies that were not published in peer-reviewed journals or in conference reports; (4) studies not published in English; and (5) outdated or insufficient information included in the document.

The literature search was performed using English databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, MEDLINE, Psychology and Behavioral Sciences Collection, PubMed, and Google Scholar. These databases were selected for their information contained on nursing education.

A three-step search strategy was implemented (33). Initially, to make sure no synonyms had been missed in the search strategy, the author and another researcher who have studied systematic reviews of literature search methods and methods of evaluating the quality of literature double-checked the Medical Subject Headings (MeSH) in PubMed and keywords that showed in the results from the initial search. The keywords used for the search were “medical student* “[MeSH terms] OR “nursing student* “[MeSH terms] OR “students, health occupations” [MeSH terms]; “community-based” [Title/Abstract] OR “service learning” [Title/Abstract] OR “service education” [Title/Abstract] OR “community education” [Title/Abstract]; “Education” [MeSH terms]; “Geriatric Nursing” [MeSH terms] OR “Senior Centers” [MeSH terms] OR “Geriatric care” [MeSH terms]; OR “Elderly” [MeSH terms] OR “Older adult*” [Title/Abstract] “Gerontologic” [MeSH terms] “Curriculum” [MeSH terms] OR “Problem-Based Learning” [MeSH terms]; “Empathy” [MeSH terms]; “Emotional Intelligence” [MeSH terms]; “caring behavior*” [Title/Abstract]. The keywords were searched as individual words and in combination using the Boolean phrase such as “AND” and “OR.” Boolean operators such as “AND,” “NOT” and “OR” were employed to combine or exclude keywords. These helped to connect the keywords during the search, to either narrow or broaden the results. In addition, secondary citations from books and journals were also used.

Secondly, more keyword synonyms were included in the search phrases in the listed databases. Thirdly, eligible publications were found by manual-searching reference lists from the included research. This was followed by a Google search of gray literature. Two distinct researchers conducted the searches and then compared and evaluated the records for inclusion. Loading citations into the EndNote 20.0 reference manager program simplifies the process of removing duplicates and screening articles for complete text. The remaining studies were examined for relevance and compared to the inclusion criteria.

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR), the researcher completed the search strategy, evidence screening and selection, data extraction, and data analysis (34). Figure 1 illustrates a PRISMA flowchart that visually outlines the processes of study identification, screening, and eligibility assessment related to the specified research question. Although the review primarily focuses on literature from the past ten years (2013–2024), older seminal studies have been included where necessary to provide a comprehensive understanding of the foundational concepts and to trace the historical development of community-based education for nursing students. This approach aligns with the flexibility inherent in scoping review methodologies, as highlighted by Munn (35), which prioritize inclusivity and a broad range of evidence to address the research objectives. A total of 3,001 records were identified and retrieved from 6 electronic databases: CINAL (n = 28); PubMed (n = 86); Web of Science (n = 2,175); MEDLINE (n = 211); Psychology and Behavioral Sciences Collection (n = 412); and Google Scholar (n = 89).

During the initial screening, 390 duplicated articles and 787 irrelevant articles were deleted, while 725 items were not retrieved. After being evaluated for eligibility, 1,021 of these records were excluded because they did not meet the inclusion criteria, specifically, that they did not investigate or assess a communication-based older people education method to support nursing students’ empathy, emotional intelligence, or caring behaviors and were mostly discussion articles. A total of 2,923 articles were excluded during this process. The full text of the remaining 78 remaining papers was then evaluated, and eight of them met the inclusion criteria. The reference lists of these eight articles were further examined for relevant studies, resulting in the identification of four additional studies. However, three of them were excluded based to the criteria. One more article was included in the reference lists. Finally, the narrative synthesis includes 9 suitable full-text articles all published between 2013 and 2024. The quality appraisal scores for the included studies ranged from 70 to 100%, based on the guidelines developed by Caldwell, Henshaw (36).

Publication dates were from 2013 until 2024, with research originating from the United States (n = 3), Canada (n = 1), Malaysia (n = 1), England (n = 1), Spain (n = 1), and Taiwan (n = 2). The total number of nursing students who participated in these nine studies was 651. Six studies were qualitative (67%), and three mixed method studies (33%).

The study selection involved a two-step process for data extraction. Two researchers independently screened the titles and abstracts based on predetermined criteria. Afterward, the remaining articles were subjected to full-text screening. For each eligible study, two reviewers independently extracted key information using a standard data extraction form, including the first author’s name, country, year of publication, study design, study aims and objectives, study population, intervention, the key findings, and limitations. Any discrepancies were resolved by a third reviewer. To record study characteristics, a data extraction table was created, quality score and key findings relevant to the review question are included in Table 1.

The critical assessment methodology proposed by Caldwell, Henshaw (36) was followed to conduct the assessment of the included literature. To analyze the advantages and disadvantages of research using qualitative, quantitative, and mixed-method designs, each paper was evaluated against 18 appraisal criteria. To determine how well each paper satisfied the quality appraisal guidelines, a percentage score was computed. The outcomes can be referred to in the quality assessment table shown in Table 2. Assessments of the risk of bias due to missing results were conducted, and each synthesis was assessed. A narrative review was employed to synthesize knowledge. Through this approach, relationships in data could be discursively explored and findings could be compared across studies using divergent methodologies.

Nursing students showed empathy improvement through the curriculum intervention aimed to improve the students’ “aging-related awareness,” “feeling toward older adults” and “interpersonal interactions with older adults” (37, 38). Negative emotions were observed to diminish during the interactions; students stated that their perspective had completely changed with regard to older adults (38). The dissolution of age-related stereotypes was one of the developments. Before the educational intervention, most of the nursing students held the opinion that “older adults are often frail and sick, they often have a patronizing attitude and are difficult to get along with, they are frequently disconnected from normal day-to-day life, they have poor work efficiency.” These original attitudes were also noticed in the study by Walton and Blossom (39). However, as the nursing students began to realize that the older adults were easy to get along with and well-mannered, their first impressions changed. Their attitude became more positive as they better understood and began to respect the selflessness of the older adults (40). The students reported a deeper emotional connection and a better appreciation of the challenges faced by older adults (41). Meanwhile, they realized that the older adults who were in their 80s were, nevertheless, still capable of caring for themselves, with some medical support. The interaction with older adults allowed students to learn directly from their experiences, which fostered a more compassionate and empathetic approach to care (38). Ultimately, the nursing students expressed astonishment at and appreciation for their aged charges, in contrast to their previous stereotypes (39). Other positive feelings that came about from these interactions with older people included compassion, caring, happiness, respect, empathy, appreciation of older adults, insightfulness, inspiration, gratitude for the encounter, and appreciation for the life-changing experience (42, 43).

Students recognized the value of what they were learning from older adults. They gained a closer understanding of the community resources and a closer look at the socioeconomic determinants of health. Students’ admiration for people with disabilities was sparked by their efforts to overcome limitations, such as the woman who cooked and baked with just one arm (41). During the participation in the “Time for Dementia” program, nursing students learned to better navigate their emotional responses and understand the emotions of dementia patients (44). Similar changes were also reported by Shropshire et al. (38) and Dobarrio-Sanz et al. (41), participants in the research noted a marked increase in their ability to empathize and understand the emotional states of older adults. Nursing students also gained valuable first-hand knowledge about the social determinants of health and living with chronic disease. They learned how to define the occasions to listen rather than interrupt or pose solutions for clients. When dealing with someone who is aging and growing less and less capable in his or her place, visiting older adults at home differs from institutional care in that it involves a sense of giving and being personally involved (40). In terms of older adults’ frustrating changes due to aging such as physical disability, students understood the significance of older adults advocacy using non-verbal communication and silent observation (37). During their weekly interactions, the nursing students eventually learned to trust their charges and converse empathetically with them (43). Most of the students and older adults became friends, with a sense of mutual understanding arising between them (37). Finally, the nursing students began to approach the topics of age and change with a constructive perspective, and there was a sense of achievement and a feeling of cheerfulness. They obtained the pathway to communicating with older adults with high emotional intelligence (37). Nursing students were able to address older adults’ concerns in a better way and so would likely appreciate any opportunity to encounter an older adult in the future.

The caring behaviors of the nursing students improved over the course of communicating with the older people. The mean score of the caring behaviors improved from 50.25 ± 9.30 to 55.75 ± 8.62, while the attitude improved from 101.9 ± 10.85 to 106.12 ± 11.52 (43). Nursing students realized the importance of having better caring skills with older adults as they truly believed that they needed to equip themselves well for work with the elderly, which would be more likely in the future (42). They learned how to create a comfortable therapeutic relationship while also improving their listening and communication skills. Not only talking but also feeling comfortable with silence, which also showed their willingness simply to “be with.” The nursing students observed the value of silence in therapeutic communication. Even limited encouragement and attentiveness were quite helpful (39). Moreover, the experience led to personal and professional growth, emphasizing person-centered care through practice, and students reflected that they were more confident in learning nursing knowledge, which will induce high-quality care (41). Caring holistically is essential to the maintenance of a therapeutic relationship. The nursing students often discussed life stories with the older adults and learned the value of hard work from them, which also inspired them to enhance their caring behaviors by exploring the skills to relax and comfort the older adults during their connection.

Students who participated in the supportive care project for older adults living with advanced chronic illness became increasingly aware of their psychological and spiritual needs, were more sensitive to ethical and legal issues, and more competent in communication. Even though they also showed concerns about old adults’ pain and other physical symptoms, they showed more subjective emotions or feelings (37, 40). By involving two senior citizens from the community in the active learning session, the nursing students realized that older people have different needs compared to the general population. They also understood how individual experience plays an integral role in managing the patient as a whole. They adapted their daily life to show their respect and did not just do everything for them. They became more confident as they better empathized and related to their elderly charges after each active session (42). The nursing students’ attitude to older adults complaining about their constant aches and pains changed from assuming they were exaggerating the discomfort to now trusting their word and empathizing with their frustration and feeling of helplessness (42).

Nursing students went into the experience of the course with a lack of confidence and nervousness but came out of it with confidence and self-assurance. The older participants were referred to by the nursing students as their “health partners.” They always welcomed students and offered hospitality. They invariably greeted each other with hugs and kisses, which brought fun and mutual respect to the interaction (38). Through these enjoyable visits, a trusting bond between the students and the older adults quickly formed. A turning point was sometimes reached when a talk of a spiritual nature occurred, or some other meaningful social interaction happened, which meant a deeper understanding then developed between the two (40). Some students said they even felt a type of love grow between them, and it was a sad day when the program, and their contact, finally ended (39). This experience provided nursing students with more knowledge and background for detecting nonverbal cues. After a while, they could tell by the older person’s expression and voice whether they were happy or sad. They understood what it meant to listen and were more sensitive to the unique needs of each patient (39).