Karen Foli

Transcript

Derek Smith:
Hello, and welcome to Baylor Connections, a conversation series with the people shaping our future. Each week we go in depth with Baylor leaders, professors, and more, discussing important topics in higher education, research and student life.
I'm Derek Smith, and today we are talking with Karen Foli. Dr. Foli serves as the inaugural Louise Herrington Endowed Chair in Mental Health Nursing. It's the first endowed chair position in the history of Baylor's Louise Herrington School of Nursing. Dr. Foli comes to Baylor from the Purdue University School of Nursing. An established researcher in the mental health of adoptive and kinship parents, as well as nurses' psychological traumas. She's devoted much of her career to alleviating the suffering caused by psychological trauma and preparing nurses to explore and build upon the science of nursing. She's a nurse, a scholar, an author, and she's with us today on the program. Dr. Foli, it's great to have you here at Baylor. Welcome, and thanks so much for joining us on the program today.

Karen Foli:
Thank you, Derek. It's a real honor to be here. I'm so glad you invited me.

Derek Smith:
Well, glad to get to know you and the work you're doing, again in that first endowed chair position in Baylor's Louise Herrington School of Nursing. So, really kind of a few months that you've been a part of the Baylor family. Certainly an exciting time to be here. But I'm curious, how would you describe those first few months of being your introduction to this university?

Karen Foli:
I would say two words come to mind. I feel very grateful and very blessed. I think Baylor's a special place. I think its Christian roots and its lived faith are very much in the practices of every day that I've come across. It's an exciting time for Baylor and the Louise Herrington School of Nursing in that the R1 research-intensive classification is still fairly new.
And I think I'm just very, very happy. The past few months have been kind of a whirlwind, but I really felt this week actually that I was really getting the hang of it.

Derek Smith:
That's good.

Karen Foli:
And getting my little command station of computers ready to go. I think I'm good.

Derek Smith:
Visiting with Dr. Karen Foli. So, Dr. Foli, I gave a very brief description of your work just a moment ago. So, let's hear how you would describe that, if you would, the areas that are important to you in your research and scholarship. How should we conceptualize the things that are important to you in the work you do?

Karen Foli:
Well, obviously, if you would look at a funnel and we start at the largest area, it would be the umbrella of mental health, obviously. If you were to tighten that up a little bit, you would look at maybe depression as another area and certainly psychological trauma.
And then, there would be kind of a bifurcation, kind of a splitting off of two general areas that I feel I have some expertise in. The first is working with adoptive, kinship, and foster parents, especially in their mental health status, and depressive symptoms, especially after the child is in the home. And then, the second area would be the psychological traumas and mental health and wellbeing of nurses, with a particular focus on new nurses and student nurses.
And you wouldn't think at first glance that those two populations would have a whole lot in common, but I think the common underlying theme would be some trauma issues. If you ever want to really know about trauma, go into the adoption community and look at the little kiddos and folks who are in adoptive or foster care right now. And they're in there, especially in foster care, because of some bad things that have happened to them and the trauma that they've endured.
But there's also what we call this notion of secondary trauma, secondary traumatic stress. So, sometimes adoptive, foster, and kinship parents can experience secondary traumas. They co-live the suffering of their children sometimes, and certainly, that is a well-established phenomenon in nursing as well. As we co-live the suffering, as we do what we call that emotional labor of nursing, we are vulnerable to that secondary traumatic stress. It's part of what we do. And the larger question is, how do we rebound from that? How do we adapt to that and still maintain our humanity and our ability to give to our patients?

Derek Smith:
That intersection, as you talk about mental health, kinship and adoptive parents, and nursing, I think most of us would recognize, "Okay, you're a nurse. You see that as you serve, as you work alongside people." When and where did you start recognizing that relationship between mental health, kinship parents, and nursing? And how did that grow into really an area of focus for you as an individual and certainly professional?

Karen Foli:
Well, I'm an adoptive parent and I realized there wasn't anything out there really that had to do with nursing and the care of these families, or very little. There were some researchers, Carol Musil, who used to be the dean at Case Western School of Nursing, and others. But there was so much interfacing between nurses and these parents.
And I do a lot of speaking right now. I do a lot of service work, to be quite honest. I just agreed to do a virtual parent support group for a agency in California, in the evening, in November. And I do it voluntarily because I want to strengthen families. And I think that's an important point, and for nurses and parents, if you can help them be better caregivers or stronger caregivers or take care of their wellbeing, I guess, is a better way of saying it, they'll be able to be better caregivers themselves.
When I first started doing the work in parental post-adoption depression, it really took off in my early book, especially The Post-Adoption Blues: Overcoming the Unforeseen Challenges of Adoption. Then later, more of a textbook for advanced practice nurses, Nursing Care of Adoption, Foster and Kinship Parents: A Clinical Guide for Advanced Practice Nurses. But there really wasn't hardly anything out there that really said, "Hey, nurses..." And a lot of the language we use now is adoption competent professionals. In other words, there's these nuances and these dynamics when you get into non-birth families that can really make a difference in terms of healthcare that they receive.
I'll give you a personal anecdote. I'm part of a conspicuous family. My daughter is a child of color. And so, I would go to the pediatrician sometimes with her and it was like I was invisible. It was like I wasn't there. I don't know if I was objectified as this person who wasn't related to my daughter. It was just highly uncomfortable and very off-putting. And I think it really diminished the care that my daughter received as well. And it happened on more than one occasion. But moreover, kinship parents, typically grandparents who were assuming the care of their grandchildren, are themselves vulnerable for many reasons, financial, maybe due to age. And they have a lot of needs that nurses need to be aware of as well.

Derek Smith:
Well, you paint a fascinating picture of some of those challenges that adoptive and kinship parents face, that you, yourself, have faced in your own family. Nurses as they deal with the traumas of others.
So, could you take us inside a little bit, what are some of the inroads to study these things? I would think there's so many different angles from which you could approach this. What are some of the key angles for you as you build this scholarship that serves others?

Karen Foli:
I think one angle is, and it's a buzzword right now, maybe it's even starting to become a little overused, I hope not, is trauma-informed care. You see that a lot right now. You see it in terms of pedagogy and teaching. You see it in terms of care. I, myself, have done some writing in it. And so, I think that it is a very great place to start.
I use a lot of the work from SAMHSA, the Substance Abuse and Mental Health Services Administration. They have a great definition of psychological trauma. And a lot of people say, "Well, what do you mean by trauma?" And that's a really, really legitimate question. And I use the 3E model where there is an event, something happens or a series of events happen. There is an experience, which is where we all kind of shift in terms of how we experience that event or those events. And certainly, there's a spiritual component to that, and some mitigators and buffers, if you will, to that experience. And then there are the effects, and that's when you get into that territory of post-traumatic stress disorder if we haven't processed that experience or if it's an ongoing accumulative trauma.
So, let me give you a couple examples. And I think if you look at one of the things that have profoundly affected me and my work, I can think of a couple of specific studies. The first study was funded by the National Institute of Food and Agriculture, and it was a project where I used what we call a Resource Parent Curriculum that was developed by experts in child traumatic stress from the National Child Traumatic Stress Network. And it had just incredible curriculum. It was myself and an extension educator, co-led groups for rural kinship parents.
And these were highly traumatized families. The children had been extensively maltreated. The grandparents had suffered extensive secondary traumatic stress, and even firsthand trauma. You had intergenerational trauma. You had parents who were, unfortunately, using substances, alcohol and opioids. And it was just a very complex dynamic. So, how do you make inroads in that? And this curriculum provided us with the tools to do that, and it provided education to the parents so that they could better understand their child's behaviors that were emanating from the trauma that they had experienced.
At the end of it, when we did some evaluation work, I remember calling a kinship parent to follow up and she was in the middle of Walmart doing some shopping. And I said, "Well, let me call you back." She said, "No, no, I want to talk to you." She said, "I don't yell anymore. I understand now. I'm not as angry as I..." And to me, that is quite profound that you can change something like that and hopefully end an intergenerational cycle.
The second study, I just completed, and it had to do with substance use in nurses and nurses' wellbeing. And the trauma that they experience as nurses can be associated with, I won't say cause, can be associated with substance use. Although again, you have a very complex profile oftentimes of nurses, maybe they've also experienced childhood trauma or whatever.
But there was one nurse who shared with me that she had been an emergency room nurse for 20 years, and in that 20 years she had often been there at the bedside when there were premature births and the infant passed. And these were miscarriages, these were not abortions. These were miscarriages. And she would have to carry the child, the baby to the morgue. And she did this for 20 years and she said no one ever debriefed her. No one ever asked how she was doing. No one ever checked on her wellbeing. And I think it just grew to the point where she fell into this pattern of trying to cope through alcohol and opioids.
And she was in recovery. She really had grown as an individual. She had stopped using substances. And I think that that publication from those findings ... I did 41 in-depth interviews. I just presented on it last week at the American Psychiatric Nurses Association Conference. And that understanding, that spreading those important testimonies and those narratives of those nurses, so that we can be more compassionate from a regulatory standpoint, is very impactful.

Derek Smith:
So, certainly when you think of who you're looking to empower, it is the nurses on the front line, but it's also policymakers, leaders. It really sounds like all up and down the ladder, almost anyone who could be associated with individuals dealing with trauma. Is that fair to say?

Karen Foli:
I think so. So, the book I wrote The Influence of Psychological Trauma in Nursing, won a couple book awards. I co-authored it with a psychiatrist, who also happens to be my husband. And I believe God really helped me write that book. There were days I would wake up and think, "I can't do this. I just can't." That imposter syndrome was quite prevalent during that time.
I think another vehicle to help people, especially new nurses, new graduate nurses, but everyone really out there. I think it gives a vocabulary to people. I have built from the knowledge in that book to formulating what we call a theory in nursing, the middle-range theory of nurses' psychological trauma, and it really goes through the seven types of specific traumas that nurses experience. And I think it's a matter of making sure that we give support to nurses in the work they do. I think that society at large is an angry society, some pockets anyway, and I think nurses take the brunt of that. The workplace violence is at an all-time high. You hear of nurses being physically assaulted. And so, they have so much to deal with. They have so much to deal with.
So, insufficient resource trauma is defined as nurses who are in positions that they don't have enough sufficient knowledge to really be competent caregivers, or they lack other nurses to help them give quality care, or they lack supplies that are sufficient to do safe care, or they lack the accessibility to other professionals, such as physicians and other professionals, to do their job. I presented briefly on this last week, and I asked for a show of hands. I said, "How many of you think this insufficient resource trauma really reaches the level of trauma?" And everybody in the audience raised their hands. So, as a practicing nurse, we all have experienced this, and it really is ... I remember 40 years ago when I was put in situations that would be called insufficient resource trauma, and they really stick with you.

Derek Smith:
We are visiting with Dr. Karen Foli, the inaugural Louise Herrington Endowed Chair in Mental Health Nursing, today on Baylor Connections.
Well, Dr. Foli, obviously the focus on mental health we've seen grow in a number of areas. You've certainly played a major role in that as you've painted that picture for us in the area of nursing, and now you get to come to Baylor to continue this work. So, I'm curious, as we head into the next few minutes of the program, I want to know what was it about this position, the Louise Herrington Endowed Chair of Mental Health Nursing and the chance to apply this trade at Baylor that drew you?

Karen Foli:
I think it was just such a wonderful opportunity. I can't say enough about Dean Plank as well. She is so transparent. She's such a incredible leader. My conversations with her as well as ... I visited at the beginning of July. I officially started August 1st. That visit in July was really pivotal to me. During that visit in July in Dallas, I met with many, if not all, of the associate deans. I think there were a couple that I was unable to meet with, but those that I met with that transported me around, took me out for meals, were so gracious. You could tell their faith played a large role in their lives and their being as nurses and as educators.
The whole atmosphere, the staff were so welcoming. Whitney Cortner, the marketing person. Linda Nunns, the administrative assistant to the dean. Just all of them. Jerchel, who works in the business office. They were all just so kind and welcoming. And when you interview, you wonder if this is sustainable. I'm a candidate. And it really is their authentic selves.
And I wanted second to that, I wanted a new challenge, and I felt I was not being challenged at Purdue. I felt that I had a lot of knowledge to share. And more than knowledge, I think it's the experience of being at an R1 institution and knowing how sometimes grants can be challenging, and how do you go about that? How do you go about writing a data-driven article? How do you go about writing a clinical article? How do you go about getting a strong abstract out there? And I just felt that I could share what I have learned over the past decades in a new experience, a new adventure, if you will.

Derek Smith:
Well, we're certainly glad to have you here doing this work at Baylor. And I think sometimes we've talked about endowed chairs and what they do in different formats here at Baylor, but for you, what does this endowed chair nursing role allow you to do and allow you to advance the work that you've described?

Karen Foli:
It's really a wonderful opportunity. I am still teasing the role out, and I think it's better to wait just a little bit before it's all defined. But I know now that I will be applying for grants, helping others apply for grants, helping Dr. Alona Angosta, who is the associate dean for research, and the marvelous work that she does, helping in supporting that. Maybe giving advice to folks, "Have you thought about this? Have you thought about that?"
Thinking in terms of a research-intensive culture, what does that mean as it's interfacing with a very teaching-intensive culture? And I'm patient. I think there's lots of time. I still have to learn a lot about the organization, but I know for right now, it's already presented me with incredible opportunities in terms of planning grants in the future, helping others submit grants. I hope to support others in terms of publication and so forth.

Derek Smith:
Well, Dr. Foli, as we head into the final moments on the program, I want to ask you, you've painted a great picture of your path to Baylor and the work that you do. I'm curious, I think you've described some of them, but I want to ask you specifically, the moments that are most meaningful to you in this work, whether it's with people who are served by your research, whether it's with students or whomever. How would you describe those moments that drive you when things are tough, the moments that are the things you hold onto, that mean the most to you?

Karen Foli:
That's a great question. And I think I would say that right now, at this point in my career is helping others channel their passions to increasing the body of knowledge in nursing and larger society.
When I talk to people and I get a feel for what is really they're passionate about ... I had a conversation with a couple Baylor faculty last week who were also at the conference, and I understood more about what they really are driven by. If I can provide any support to help them mobilize, actualize their passions through science, through research, through teaching or whatever, I would really enjoy doing that right now.
I think sometimes I've had to learn through trial and error, the hard way, or by myself. And I feel like I've learned a great deal, and if I can share that with others so that they can, again, fuel or channel that passion, that energy, that drive in good ways, then that would be very fulfilling for me.

Derek Smith:
Well, Dr. Foli, we're glad to have you here at Baylor. We're excited to see the fruit of the work and more of those moments that you just described. I want to thank you for taking the time to join us today and share with us, and we'll have to talk to you again one of these days as we see the work you do in this role expand and grow.

Karen Foli:
Thank you so much, Derek. It's been a pleasure.

Derek Smith:
Well, it's great to have you with us. Dr. Karen Foli, the inaugural Louise Herrington Endowed Chair in Mental Health Nursing, our guest today on Baylor Connections.
I'm Derek Smith. A reminder, you can hear this and other programs online at baylor.edu/connections, and you can subscribe to the program on iTunes. Thanks for joining us here on Baylor Connections.