Hi nurses!

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In Today’s Issue:

🔗 The best resources I found this week
📖 Deep dive: Part 2 of 3: The Hard Conversations - Real Situations You'll Face
🩷 Self-care moment

Know a co-worker who would benefit from this newsletter? Subscribe here
Want to learn how to get Forget Me Not Boxes in your hospital? Reply “Bereavement boxes”

🔗 The Best Resources I Found This Week

🌍 Newly released multilingual bereavement resources to give to your loss parents. It guides them in the early days of their grief journey in their preferred language. (Gemma’s Hope)

📖 Deep Dive

Part 2: The Hard Conversations - Real Situations You'll Face

Last week, we covered the basics of getting those first crucial moments right. Today, we're diving into the messy, complicated situations that don't have neat scripts - the moments that keep you up at night wondering if you said the right thing.

These are real experiences from nurses in our community - a combination of stories from nurses supporting families through stillbirth and experiences they've had navigating their own grief while caring for others. Let's talk through the hard stuff together.

When Emotions Hit You Unexpectedly

This is completely normal, and you're not alone. Research shows that healthcare providers experience grief remarkably similar to the families they serve - sadness, helplessness, and often questioning their own competence. Studies reveal that 84% of nurses report emotional responses including sadness, anxiety, and guilt when caring for families during stillbirth.

What's happening neurologically is that witnessing traumatic events activates the same stress response systems as if you experienced them yourself. Dr. Papadatou's Model of Health Professionals' Grieving Process explains that professional grief differs from personal grief because it's anticipated daily and often "hidden in private shadows".

Immediate strategies when emotions surface:

• Take three deep breaths and ground yourself in your role as a caregiver

• Remember that showing appropriate emotion demonstrates your humanity, not weakness

• Use the "curtain" technique - acknowledge your feelings while keeping the focus on the patient.

• Step away for a moment if possible to collect yourself

• Have a designated support person for yourself

When You Need to Compartmentalize But It Doesn't Work

Research confirms this is a universal experience among healthcare workers. Multiple studies identify "compartmentalization" as a primary coping mechanism, with nurses describing "boxing or curtaining off" their feelings to maintain professional composure. However, this emotional suppression often backfires.

A study of critical care nurses found that compartmentalization helps during the shift but often leads to delayed emotional responses. Nurses report crying in their cars, having trouble sleeping, or feeling emotionally depleted after work. As one study participant noted: "You'd be an emotional wreck if you let it bother you or affect you all the time".

Why delayed grief happens:

• Professional culture pressures emotional suppression

• Cumulative exposure to multiple deaths without processing time

• The brain's natural stress response doesn't disappear just because you're "professional"

Healthier approaches:

• Allow brief emotional acknowledgment during your shift when safe to do so

• Create transition rituals between work and home

We have more reading on this topic here: How do I cope after a demise? A Nurse's Guide to Coping with Infant Death

The Minefield Question: "How Many Children Do You Have?"

This question haunts many nurses who have experienced their own infant or child death. Research shows there's no single "right" approach - what matters is honoring your own boundaries and recognizing that your answer can change day by day.

Common approaches nurses use:

• Some prefer to say: "I have four kids, three living"

• Protect emotional bandwidth: Only mention living children

• Gentle redirect: "I have children. Tell me about yours"

• Honest boundary: "That's a tough question for me that’s hard to talk about right now.”

Studies show that nurses feel guilt regardless of their choice - guilt for not mentioning their baby who died, or guilt for mentioning them and worrying it might bring heaviness to the family. Your boundaries are valid, and protecting your emotional health is essential for longevity in this work.

More reading on this topic here: The Realities of Caring for IUFD When You’ve Experienced Your Own Loss

Presenting Memory-Making Options Without Falling Apart

Research by Kingdon et al. shows that how we present memory-making options dramatically influences both parents' decisions and their later feelings about the experience. When healthcare providers approach these opportunities with confidence, parents are more likely to participate and later report positive associations.

The evidence is clear: parents who initially say no to photographs often deeply regret this decision later. Studies show that professional bereavement photography significantly aids families' grieving process by providing lasting, dignified images.

Confident presentation strategies:

• Approach memory-making as a natural part of care, not an uncomfortable add-on

• Use phrases like "Many families find it helpful to..." rather than tentative language

• Acknowledge that it might feel overwhelming now, but they can decide later

• Create multiple sets of keepsakes in case parents are separated

Remember: Your confidence in presenting these options directly impacts how families experience this crucial decision.

Finding Time for Debriefing (When There Is No Time)

This is one of the most significant gaps in healthcare - research shows that only half of hospitals have standard debriefings after perinatal events. Yet studies consistently demonstrate that structured debriefing significantly reduces secondary traumatic stress and improves team resilience.

Evidence-based debriefing approaches:

• Immediate huddle: 5-minute team check-in before shift change

• 24-72 hour structured debrief: More formal processing once emotions settle

• Peer support pairs: Buddy system for one-on-one processing

• Written reflections: When verbal debriefing isn't possible

A comprehensive study found that nurses who received structured debriefing support showed significant improvement in mental and emotional outcomes. Even 30 minutes of group processing can dramatically reduce anxiety and depression levels.

When Your Psychological Stress Feels Too Similar to Theirs

You're describing secondary traumatic stress, and research confirms this is remarkably common. Studies show that nurses experience grief symptoms remarkably similar to the families they serve. This isn't weakness - it's evidence of your empathy and humanity.

However, when your psychological stress mirrors the families', it can lead to complicated grief, emotional exhaustion, and even leaving the profession. Recent research reveals a concerning finding: nurses with higher confidence in bereavement care actually show increased rates of secondary traumatic stress. As you become more skilled and emotionally invested, you may absorb more of the family's grief.

Maintaining healthy boundaries:

• Recognize that your grief is different from theirs - you return to work, they go home forever changed

• Use the "professional grief" framework - this is anticipated as part of your chosen work

• Implement the curtain technique for emotional protection during patient care

• Seek specialized support designed for healthcare providers experiencing secondary trauma

When You Feel Emotionally Overwhelmed and Unprepared

Research consistently shows that early career nurses are particularly vulnerable to death anxiety and grief responses. A study of hundreds of nurses found that younger nurses under 30 experience higher levels of grief and death anxiety. You're not failing - you're human.

The truth about experience: It doesn't get easier, but you develop better coping strategies and confidence in your ability to help families. Veteran nurses report that each loss still affects them, but they've learned to process grief more effectively.

Building resilience as a new nurse:

• Seek formal death education and bereavement training

• Find a mentor who can guide you through difficult cases

• Remember that feeling unprepared is normal - even experienced nurses feel this way

• Focus on presence over perfection - families remember your caring, not your expertise

More reading on this topic here: 4 Truths Every L&D Nurse Should Know about Fetal Demise

Finding the Right Words in the Moment

In our recent survey, 31 out of 216 nurses identified this as their biggest challenge - knowing what to say or finding the right words when caring for families after stillbirth. You're in the majority, not the minority.

Research shows that your presence often matters more than having perfect words. Studies of bereaved parents reveal they may not remember your exact words, but they always remember how you made them feel.

Evidence-based communication strategies:

• Use clear, direct language: "I am so sorry your baby has died"

• Follow the family's lead with language and the baby's name

• Remember that silence is often more healing than searching for words

• Simple phrases work: "I wish things were different," "I'm here with you"

More reading on this topic here: Finding the Right Words—What to Say (and Not Say) to Families After Stillbirth or Miscarriage

When You Know They Already Know

You're absolutely right - research shows 84-90% of families already know before arriving at the hospital. This requires a completely different communication approach than breaking devastating news.

For families who already know:

• Shift from "breaking news" to acknowledging their reality

• Validate their experience: "I can only imagine how difficult this has been"

• Focus on what happens next rather than the diagnosis

• Use their baby's name if they've shared it

• Ask what they need rather than assuming

Your role becomes:

• Companion rather than messenger

• Guide through the process rather than breaker of news

• Validator of their parenthood and grief

Handling Hard Questions: "Why Did This Happen?"

"Parents keep asking me why their baby died, and I never know what to say. How do I respond when there are no answers?"

This is one of the most challenging questions because 25-60% of stillbirths remain unexplained even after thorough investigation. The research shows that the unexplained nature of many cases adds to emotional trauma regardless of when the diagnosis is made.

Evidence-based responses:

• Acknowledge the question's importance: "That's such an important question"

• Be honest about uncertainty: "I know how much you need answers. Sometimes we don't have them, and that makes this even harder"

• Avoid false reassurances when you're uncertain about outcomes

• Offer to connect them with their doctor for medical explanations

• Validate their need for answers while acknowledging the limits of what you know

👉 Remember: Your role isn't to have all the answers - it's to support them through not having them.

Navigating Unhelpful Family Members

"Sometimes family members make everything harder for grieving parents - they minimize the situation, give unwanted advice, or try to take control. How do I handle this?"

Research shows this is incredibly common. Family members may unintentionally minimize the experience, offer unhelpful advice, or pressure parents to "move on" too quickly. Studies indicate that poor social support is strongly associated with complicated grief reactions.

Evidence-based strategies:

• Set clear boundaries: Support parents in communicating their needs to family

• Advocate for the parents: Gently redirect conversations that aren't helpful

• Normalize diverse grief responses: Remind families that everyone grieves differently

• Facilitate family meetings: Help parents share their needs before visitors arrive

• Provide education: Offer resources to visitors about supportive behaviors

More reading on this topic here: Family in the Room: Tips for When Support Isn't So Supportive

Supporting Different Grief Responses

Research consistently shows that grief responses vary dramatically between individuals and cultures. There's no "right" way to grieve, and expecting uniformity causes additional pain.

Evidence-based approach:

• Follow each person's lead rather than expecting consistency

• Validate all emotional responses as normal

• Ask what each person needs rather than assuming

• Respect cultural and spiritual preferences without imposing your beliefs

• Remember that the same person may grieve differently from day to day

When someone responds with anger: "It's okay to feel whatever you're feeling. I'm here with you"
When someone is silent: Offer presence without pressure to talk
When someone wants to talk: Listen actively and let them lead the conversation

👋 That’s a Wrap!

Before you go: Here are ways we can help your hospital

We offer bereavement boxes to give as gifts to those who leave the hospital after a miscarriage, stillborn, or infant death. Reply to this email “Sample” to get a free sample sent to your hospital.

What we prioritize:

1. Tools for hospitals to create a bereavement experience for families to begin their grief journey

2. Educating nurses with modern bereavement standards and continuing education.

3. Helping hospitals build a foundation of trust and support, so bereaved families feel seen and cared for—now and in the years to come.

These boxes were born out of our own personal losses, including Jay’s (CEO) 15 years of experience working in labor and delivery as a CRNA and witnessing time and again how the hospital experience can profoundly shape a family’s grief journey, for better or for worse.

Until next week,

Trina and Jay
Co-founders of Forget Me Not