---
title: Perinatal Hospice Nurse Wellness Check Form Template | Paperform
description: Confidential wellness check form for perinatal hospice nurses supporting pregnancy continuation, birth planning, memory-making, and anticipatory grief care. Trauma-informed and compassionate.
url: "https://paperform.co/templates/perinatal-hospice-nurse-wellness-check"
type: static
generatedAt: "2026-03-28T00:44:45.363Z"
---

[← Back to free form templates](/templates/)    ![Perinatal Hospice Nurse Wellness Check](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/perinatal-hospice-nurse-wellness-check.png)
    [Preview](https://_preview.paperform.co/ai-template/perinatal-hospice-nurse-wellness-check) [Use this template for free](/create?ai-template=perinatal-hospice-nurse-wellness-check)    [Emergency & Crisis Forms](/templates/category/emergency-crisis/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Hospice & Palliative Care](/templates/industry/hospice/) [Nurse](/templates/role/nurse/)[Counselor](/templates/role/counselor/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Supporting Those Who Walk Alongside Families in Their Most Sacred Moments

Perinatal hospice nursing requires extraordinary emotional resilience, clinical expertise, and spiritual capacity. This **Perinatal Hospice Nurse Wellness Check** form provides a confidential, trauma-informed space for nurses to assess their own well-being while navigating the profound privilege and weight of supporting families through pregnancy continuation after life-limiting diagnoses.

#### Why Regular Wellness Checks Matter in Perinatal Palliative Care

Nurses working in perinatal hospice hold space for families experiencing anticipatory grief while celebrating life, coordinating compassionate birth plans, and facilitating precious memory-making. The emotional labor of this sacred work—bearing witness to both profound love and immense loss—can lead to compassion fatigue, vicarious trauma, and moral distress without proper support systems.

#### How This Form Supports Perinatal Hospice Teams

Built specifically for **healthcare organizations, hospice programs, and maternal-fetal medicine departments**, this wellness check addresses the unique stressors of perinatal palliative care work. It explores emotional capacity, boundary maintenance, grief processing, team support needs, and self-care practices while honoring the deeply meaningful nature of this specialized nursing role.

The form uses trauma-informed language and provides space for both quantitative wellness indicators and narrative reflection. Healthcare leaders can identify team members who may benefit from additional support, supervision, or respite before burnout takes root.

#### Integrate Wellness Checks into Your Care Team Rhythms

With **Paperform**, you can schedule regular wellness checks (monthly or quarterly), customize questions to your program's unique culture, and route responses appropriately based on urgency level. The form's conditional logic adapts to individual responses, ensuring nurses receive relevant follow-up questions without creating unnecessary burden.

For teams implementing comprehensive wellness programs, connect this form to **[Stepper](https://stepper.io)** to automatically trigger supportive interventions—scheduling supervision sessions, sending resource materials, or alerting wellness coordinators when critical support indicators are flagged. You can also integrate with **[Papersign](https://papersign.com)** for any follow-up care plans or wellness agreements requiring documentation.

Caring for perinatal hospice nurses means honoring their profound work while ensuring they have the emotional resources to continue serving families with compassion, presence, and clinical excellence. This wellness check form is one small but significant way to provide that care.
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