Reflective Writing to Support Nursing Students' Ethical Understanding of End-of-Life Care: A Phenomenological Study

End-of-life care requires nurses to integrate ethical sensitivity, emotional presence, and effective communication. Reflective writing, a key component of Narrative Medicine, offers nursing students a structured method to process complex emotional experiences and deepen their ethical understanding. This study investigated how third-year nursing students reflected on ethical issues and emotional responses related to end-of-life care through a structured reflective writing activity conducted after a film-based educational session. A qualitative phenomenological approach was applied to analyze 55 written reflections produced by Italian nursing students. The reflections were collected following a classroom screening of a film portraying terminal illness and decision-making at the end of life. Data were examined thematically using Braun and Clarke method. Four key themes emerged: emotional responses to death; relational and ethical dynamics; communication and connection; and temporal-spiritual meaning-making. Students' reflections revealed an emerging awareness of ethical dimensions such as patient autonomy, vulnerability, and the value of nonverbal communication. Through reflective writing, participants articulated emotions including fear, anger, and guilt and engaged in personal meaning-making related to self-determination and compassionate care. Overall, reflective writing facilitated the development of ethical awareness and emotional resilience among students preparing for palliative care practice. The integration of structured reflection into hospice and palliative nursing education may enhance students' readiness to deliver empathetic, person-centered care.