Ethical issues in nursing care for older adults in community settings: A scoping review.

Abstract

BackgroundEthical issues in nursing care for older adults in community setting are becoming more visible as population aging accelerates. However, existing studies are fragmented and lack a comprehensive synthesis to inform ethical practice and governance.AimsTo identify major ethical issues, their impacts, and related strategies in nursing care for older adults in community setting, providing evidence for ethical practice, education, and policy development.MethodsA scoping review was conducted following JBI methodology. PubMed, Web of Science, Scopus, CINAHL, Ovid-Embase, PhilPapers, and PsycINFO were searched up to 8 February 2026. Two reviewers independently screened, extracted, and synthesized data.ResultsFourteen studies were included in this review. Evidence was synthesized at three levels including nursing staff, older adults, and the care system, and categorized into three domains: ethical challenges, ethical impacts, and improvement strategies. Ethical challenges mainly arise from three aspects: role ambiguity and competence limitations among nursing staff under contextual constraints, restrictions on older adults' autonomy and opportunities to participate in decision-making, and structural conditions related to resource allocation and governance mechanisms. These ethical issues manifested as increased moral distress and emotional strain among nurses, diminished trust in nurses and reduced care adherence among older adults, and systemic pressures on the quality, equity, and sustainability of community nursing services. To address these challenges, the literature proposed strategies including strengthening ethics education and reflective practice, promoting supportive communication and shared decision-making, and improving governance structures and resource support.ConclusionsEthical issues in community nursing for older adults demonstrate multilevel characteristics embedded within practice contexts and institutional conditions. Strengthening ethical competence, promoting supportive communication and participatory decision-making, and advancing institutionalized ethical governance are essential for fostering more equitable and sustainable community nursing practice. Future research should expand geographical representation and further strengthen the evidence base for ethical governance in community nursing through high-quality empirical studies.