The American Nurses Association (ANA) 2019 Code of Ethics for Nurses with Interpretive Statements (The Code) establishes that nursing practice is based on the compassion and respect for the inherent dignity, worth, and unique attributes of every person (ANA, 2019). Competent, effective, person-centered and holistic nursing care is characterized by understanding the intersection of racial identity, personalized health risk factors, and culturally appropriate interventions. The purpose of this article is to synthesize information relevant to nursing care on racial identity formation and racial ambiguity for people with a history of transracial adoption. This work is particularly timely and urgent as the ANA has recently pledged to oppose and address all forms of racism and discrimination.

While this information is relevant to all care settings, expert nursing cultural competence for people who are transracially adopted is particularly poignant for nurses practicing in behavioral health, school health, pediatrics, refugee camps or other international settings where unaccompanied minors may be considered for international adoption. This information is also relevant for nurses who practice in settings where victims of human trafficking most often present for episodic care.

Nursing Practice and Transracially Adoptive Patients

...positive psychosocial, academic, and health behaviors are associated with strong ethnic and racial identity, particularly for African American adolescentsBecause the process of adoption generally involves an early life separation from the birth parent(s), people with an adoption history may experience early life traumatic stress. This stress can have potentially cumulative detrimental impacts on health if left unaddressed. Trauma exposures for children adopted from foster care increase the risk of adolescent and adult emotional and behavioral health problems (Blake, Ruderman, Waterman, & Langley, 2021). People with an adoption history, in general, have a higher risk of suicidal ideation and behavior (Festinger & Jaccard, 2012; Keyes, Malone, Sharma, Iacono, & McGue, 2013); psychiatric illness (Hjern, Lindblad, & Vinnerljung, 2002); and lifelong substance use disorder (Yoon, Westermeyer, Warwick, & Kuskowski, 2012), with transracial and international adoptees remaining at heightened risk for self-injury throughout most of adulthood (Hjern, Palacios, Vinnerljing, Manhica, & Lindbald, 2020). Furthermore, positive psychosocial, academic, and health behaviors are associated with strong ethnic and racial identity, particularly for African American adolescents (Rivas-Drake et al., 2014). However, little is known about the health protective or health risk intersection of ethnic and racial identities with transracial adoption, or if transracial adoption generates a unique bicultural identity among these transracial families (Tikhonov, Espinosa, Huynh, & Anglin, 2019). It is important for nurses to consider the unique health risk and protective factors for people who have been adopted to meaningfully assess, plan, treat, and evaluate culturally relevant nursing care.

...check-box answers may create an overly-simplified façade for deeply complex identity formation and group belonging.The most basic standard healthcare access, forms, and assessments generally include a request for racial and ethnic identity, in which check-box answers may create an overly-simplified façade for deeply complex identity formation and group belonging. Nurses are often trained to understand and support human needs and development through Maslow’s hierarchy of physiological, safety, love/belonging, esteem, and self-actualization (Maslow, 1943). Here, we relay the nuances and potential stressors inherent to adoption-related racial identities that may increase the risk for discrimination or stigma and create barriers to both 1) accurate assessments in the healthcare setting and 2) a full sense of love and belonging within a social, racial, cultural, or identity group.

Re-Examining Transracial Adoption Practices
...within the space of transracial adoption, many are re-examining how racism, bigotry, classism, and other biases may have unjustly influenced past transracial adoption practices. Issues surrounding racial identity and its formation within the context of adoption have been the object of scrutiny, particularly as the practice of transracial adoption is considered. Transracial/transcultural adoption is defined as when a child of one race or ethnic group is placed with parent(s) of a different race or ethnic group (Child Welfare Information Gateway, 1994). The overriding principle that has guided adoption practices, laws, and regulations for the past century considers the best interests of the child according to the dominant cultural norms. However, within the space of transracial adoption, many are re-examining how racism, bigotry, classism, and other biases may have unjustly influenced past transracial adoption practices. Here, we provide an overview of pertinent epidemiology, policy, racial identity development, and health disparities to inform cultural competency development and future directions in the nursing care of patients who are transracially adopted.

Epidemiology of Transracial Adoptive Families
The 2010 Census marked the first time the United States (US) attempted to count the number of children who were adopted at the national level (Kreider & Lofquist, 2014). Including both domestic and internationally adopted children, approximately 2.3% of all children (or 2 million children counted in 2010 Census) were adopted with an estimated one in four adoptive families being transracial (Kreider & Lofquist, 2014). White adopted children accounted for 762,092 of the total number of adopted children while Black or African American accounted for 251,002 of the total number (Kreider & Lofquist, 2014).

For the United States as a receiving country, international adoptions peaked between 1994 (9,000 children per year) and 2004 (almost 23,000 children per year) (Selman, 2009). Due to several factors, including the Hague Treaty discussed below; increased interest in domestic adoptions within the sending country, and concerns over the treatment of children received by U.S. parents, these numbers dropped in 2019 to 2,971 children adopted from other countries (Selman, 2012; U.S. Department of State, 2019).

...a disproportionate number of children who are not formally adopted in the foster care system are minorities.The primary source of information about foster children in the household is the Adoption and Foster Care Analysis and Reporting System [AFCARS] (U.S. Children’s Bureau, 2020a). In 2019, 66,000 children were adopted from the foster care system, an increase from 63,000 in 2018 (U.S. Children’s Bureau, 2020b). However, a disproportionate number of children who are not formally adopted in the foster care system are minorities. Of the 423,997 children who were not officially placed in the foster care system as of September 2019, 44% were white; 23% Black or African American; 2% American Indian/Alaska Native; 1% Asian; 21% Hispanic of any race; and 8% were of two or more races. Comparing these figures with 2020 Census race and Hispanic origins, Black or African American children (23% versus 13.4%) as well as those children of two or more races (8% versus 2.8%) are disproportionally over-represented in foster care awaiting placement when compared with the total U.S. population (see Table 1; U.S. Census, 2019).

Table 1. Comparison of Race and Hispanic Origin between Foster Care and Total Population

Note: 2019 Census: Hispanic or Latino-also included in applicable race categories. 

Children exit foster care due to several officially recorded reasons, including reunification, adoption, and guardianship. We acknowledge that there may be additional reasons children exit the foster care system that are hidden or difficult to officially record, such as running away, homelessness, human trafficking, or self-emancipation (including the minor child becoming a parent themselves through pregnancy/giving birth). While this article focuses on racial identity formation among people who were adopted transracially, the same trauma-informed nursing care principles apply to foster children placed with transracial caretakers and families.

Trauma Informed Nursing Care for Patients with Transracial Adoption Histories

Transracial adoption may create a unique cultural consideration of how patients perceive trauma, safety, and identity...Transracial adoption may create a unique cultural consideration of how patients perceive trauma, safety, and identity which are discussed in further detail later in this article. When patients disclose a history of adoption, nurses then consider if screening for trauma history is appropriate to the reason for seeking healthcare and a therapeutic relationship. Abuse and neglect that may precede foster care and adoption placements are commonly known as adverse childhood experiences that can negatively affect physical and mental health throughout the lifespan (Felitti et al., 2019). Even infants voluntarily relinquished by biological parents can experience injuries to emotional attachment bonds formed prenatally with the biological parent(s), which can impact the most basic elements of early childhood brain development and stress response (Cakirli & Acikgoz, 2021; Vogel, Brito, & Callaghan, 2020).

Further, transracial adoption presents consideration and nuance for racial identity development that may uniquely impact each individual differently, with risks for social isolation or limitations in ethnic or cultural social support. Culturally responsive nursing care begins with competency to receive a relinquished infant in a clinical setting designated as a safe haven (Rousseau & Friedrichs, 2021) and screening for potential victims of human trafficking (Donahue, Schwein, & LaVallee, 2019). To provide care for the patient with transracial adoption history, culturally responsive nurses will consider interventions such as referral to emotional support groups, counseling, socialization enhancement, support system enhancement, substance use prevention and screening, traumatic stress symptom screening, and facilitation of organizational resource development relevant to adoption history.

...transracial adoption presents consideration and nuance for racial identity development that may uniquely impact each individual differently...Through a trauma-informed lens, nurses can further assess the adoption history in relation to the three “E’s” of trauma: event, experience of event, and effect with a response based on the four “R’s” assumed in a trauma informed approach: realize, recognize, respond, and resist re-traumatization (see Table 2).

Table 2. Three E’s and Four R’s of Trauma-Informed Nursing Care for Patients With a History of Transracial Adoption

(Substance Abuse and Mental Health Services Administration [SAMHSA], 2014)

Federal and International Laws and Racial Identity Formation

...nurses should be knowledgeable about historical practices surrounding transracial adoption.In addition to the 4 Rs of trauma-informed approaches, nurses should be knowledgeable about historical practices surrounding transracial adoption. A full review of the history of adoption is beyond the scope of this discussion; however, the practice of adoption can be summarized by early Indigenous cultural influences (Gallay, 1996) and three modern “waves” (Johnson, 2019). Early Indigenous adoption practices appeared inherently and intentionally cross-cultural to integrate disaster crisis survivors and refugees of other tribes, bands, and races (Gallay, 1996). After adoption, people were treated as if their blood and internal being assumed actual biological kinship with the people who adopted, and their pre-adoption internal essence, status, and identity was considered profoundly transformed within the adoptive relationships.

After adoption, people were treated as if their blood and internal being assumed actual biological kinship with the people who adopted...The first modern wave, in the late 19^th and early 20^th centuries, saw healthy infants placed in homes when institutional care of children was deemed insufficient. The second wave in the late 1960s through the 1990s was characterized by a decrease in abandoned and relinquished infants as access to domestic reproductive health services drastically improved, paired with international crises of food insecurity and famine (Johnson, 2019). The third and present wave of adoptions is noted for the decline in intercountry adoptions and an increase in foster care adoption, in part due to the Adoption and Safe Families Act of 1997, which sought to decrease the time to placement for children. Currently, the adoption community and its healthcare providers recognize that children adopted from both other countries and domestically have the potential for medical problems and other developmental and emotional challenges (Johnson, 2019). With modern waves two and three, transracial adoptions were practiced with increased frequency as intercountry adoptions (Wave 2) and domestic adoptions (Wave 3) waxed and waned. Table 3 presents key shifts in ideological practices surrounding transracial adoption.

Table 3. Key Domestic Policies, Organizations, and Social Movements

Domestic Adoption Policy
Events demonstrate that historically, racial identity formation in children other than white-only has been subverted by forced placements with white parents. Adoption is not merely a cultural practice; its formation and fluidity are influenced by law, social norms, and our notions of the family unit. Events demonstrate that historically, racial identity formation in children other than white-only has been subverted by forced placements with white parents. Table 3 summarizes key domestic policy, organizations, and social movements. Concurrent with the Civil Rights movement of the mid-20^th century, adoption policies tended to misapply a colorblind notion to transracial adoption and foster placement. It is noteworthy that claims of a colorblind worldview characterize the earliest, unformed, and often most immature, stage of white racial identity formation (Helms, 1997). Likewise, critics also addressed the “color-blindness” of the 1990s Multiethnic Placement Act (MEPA) and Interplacement Ethnic Act (IEP) laws (Evan B. Donaldson Institute, 2008). For example, The NABSW (2003) stated all three laws from the 1990s, the MEPA, IEP, and Adoption and Safe Families Act (ASFA), did little to support racial inequities in transracial adoptions that continued to favor prospective white adoptive parents, and which included policies that were seen as contradictory to the “realities of an unwieldy child welfare system” (p. 2).

The goal was to optimize biological or first family unification and reunification with support to structure a safe, healthy, and nurturing home environment to raise childrenIn 2018, the Family First Prevention Services Act (FFPSA) was passed as a means to overhaul the foster care system and decrease the increasing number of children, particularly children of color, placed in foster care. This law will be phased in over the coming years; the soonest the impact will be seen is 2027. The goal was to optimize biological or first family unification and reunification with support to structure a safe, healthy, and nurturing home environment to raise children (Garcia, 2019). Implementation of the FFPSA presents an important and timely opportunity at all levels and settings of nursing practice, including home visiting program interventions, focused on substance use prevention and treatment, child maltreatment prevention, healthy parenting, and mental health support for families with children.

Intercountry Adoption Policy
...transracial placements of children via intercountry adoptions have plummeted in recent years. As described in Wave 3 (Johnson, 2019), transracial placements of children via intercountry adoptions have plummeted in recent years. Several factors account for this decrease; however, the international treaty, known as the Hague Convention of 29 May 1993 on the Protection of Children and Cooperation in Respect of Intercountry Adoption (referred to as the 1993 Hague Convention) was one driving force. The treaty was intended to decrease conflicts of interest in parties arranging for adoptions and decrease human trafficking of children as scandals and concerning narratives from birth parents surfaced as to unscrupulous practices that removed children from birth/first parents in countries that send children to the United States for adoption (Selman 2012). Much of the current evidence on transracial adoption identity development has come from the study of intercountry adoption practices (Evan B. Donaldson Institute 2008; 2009).

Individuals Who are Transracially Adopted and Racial/Ethnic Identity Formation

Racial/Ethnic Socialization in Non-Adoptive Families
Little is known about the health protections, nuances, and challenges of racial identity formation for people who are interracially adopted across the lifespan. Here, we review similar information from non-adoptive families and multi-racial families, acknowledging this gap is specific to adoption. The majority of adoptive parents are racially categorized as white (Child Welfare Information Gateway, 1994). Racial/ethnic socialization and identity formation has been a topic of study in non-adoptive families since the 1980s.

In a review paper, Hughes et al. (2006) described four parental patterns of messages that surround children’s ethnic-racial socialization. The first pattern identified is cultural socialization, which includes “…children’s cultural, racial, and ethnic pride, either deliberately or implicitly” (p. 749). In this theme, parents take pride in passing down pieces of their heritage and racial identities to their children and do so in a variety of ways. The second theme, preparation for bias, reflected studies that suggested that parents communicate the discrimination in society and how they can cope with this. This theme seems to echo the NABSW (1972) position statement that asserted Black parents instill such an awareness and prepare their children to face discriminatory practices. The third theme was promotion of mistrust, within the context of interracial interactions; these messages do not contain how to cope with potential bias from other racial/ethnic groups. The final theme identified by Hughes and colleagues (2006) is egalitarianism and silence about race. In these studies, parents emphasized individual behaviors and qualities over racially divided groups. Considering the additional layer of adoption itself and subsequent adoption socialization, the discussions related to racial and ethnic identity become confounded. 

Racial/Ethnic Socialization in Mixed Heritage Families
...identity formation for mixed heritage families may offer insight into the developmental racial identity processes for people who have been interracially adopted.Similar to biological heritage and racial/ethnic socialization, identity formation for mixed heritage families may offer insight into the developmental racial identity processes for people who have been interracially adopted. Multi-racial parents tend to classify their child’s race differently across different contexts and align with themes of identification 1) by physical appearance, 2) by the parents’ cultural norms and traditions, 3) as bi-racial or multi-racial with internalized but compartmentalized components of each separate portion of one’s heritage, 4) as mixed with the integration forming a novel ethnic grouping, and 5) as cosmopolitan or ambivalent in either setting aside or transcending racial identity as irrelevant to daily life and unimportant to individualistic identity (Song, 2017). Racial identity formation in the presence of this ambiguity may incorporate the adoptive family’s emphasis on transmitting their own racial/cultural identity, the child’s link to biological ancestry, external social validation and assumptions due to the child’s physical appearance, and community acceptance or rejection of the adopted person’s internal racial identification.

Adoption and Racial Identity Formation
Two landmark documents from the Evan B. Donaldson Institute (2008; 2009) addressed adoption and racial identity formation. The first offered a critical review of the literature and the national laws influencing transracial adoption. Three overall challenges to children who are adopted transracially were identified: coping with being different; struggling to develop a positive racial/ethnic identity; and ability to cope with discrimination and bias (Evan B. Donaldson Institute, 2008). The second report (Evan B. Donaldson Institute, 2009), based on a national study, offered an overview of both adoption and racial identity formation. Central findings included how the importance of adoption identity increases as the child ages into adulthood, as does race/ethnicity identity for those who are adopted transracially. For example, Korean adoptees considered themselves to be white as children, although this identity dissipated as a child reached adulthood. The most effective efforts to support a positive racial/ethnic identity included active engagement by the individual in this formation through “lived experiences” such as travel to biological kinship country, attending racially diverse schools, and having role models of their biological kinship race/ethnicity. Last, adoption and racial identity factors can differ by gender and biological kinship race (Evan B. Donaldson Institute, 2009). The intertwinement of adoption and racial identity formations, and discriminations, cannot be overemphasized.

The intertwinement of adoption and racial identity formations, and discriminations, cannot be overemphasized.Controversy surrounding transracial family formation suggests that the child will not have the benefit of same race/ethnic parents and/or siblings as a nonadoptive individual. Therefore, the child will struggle with racial identity formation, including the ability to prepare for and navigate a world that is not colorblind, nor void of racism and discrimination. There are numerous studies that detail the outcomes of children/adults based on transracial adoption with evidence that both supports and refutes the practice. The issue then becomes whether transracial adoption is in the best interest of the child when faced with uncertain futures in sending countries and prolonged foster care placements in the United States. An unexplored empirical question would consider a comparison of racial identity of Black children raised in homes with Black parents versus homes with white or white-passing parents (Butler-Sweet, 2011).

Black or African American heritage and identity have also been scrutinized within the context of domestic and intercountry transracial adoption (Raleigh, 2016). Structural racism and historic racial and ethnic hierarchy in North America have created unjust biases against descendants of the Transatlantic Slave trade diaspora, even compared to people with the same racial identity and skin color descending from more recent immigrations (Kendi, 2020). These biases may translate into adoption practices. Adoptive parents appear to be more willing to adopt Black “foreign-born and biracial black children,” children seen as “not black,” rather than domestic Black children in foster care (Raleigh, 2016, p. 86). Thus, there may be nuanced racial versus ethnic demarcations, distinctions, and subgroups that are not yet well explored as an intersection with adoption history.

Black children adopted to white parents have unique experiences.Black children adopted to white parents have unique experiences. There is an omnipresence of conspicuousness and yet a simultaneous absence of identifying with similar individuals; a discordant experience in race between adult adoptees and their parents; and an effort to manage societal perceptions of race and expectations of being Black (enough) or white (Samuels, 2009). In Their Own Voices (Simon & Roorda, 2000) offered an account of Black and biracial men and women who were adopted by white parents. Twelve women spoke about their experiences growing up and emerging into adulthood; all but one of the women support transracial adoption, and they are clear about what is necessary to instill racial identity. Informants emphasized how white parents needed to learn more about Black history, live in mixed neighborhoods, attend events with Black families and so forth (Simon & Roorda, 2000).

One pervasive pattern appears in the empirical literature as racial/ethnic identity for children who are transracially adopted: exploration of family communication related to racial/ethnic socialization and preparation for bias/discrimination, and the outcomes of these dynamics. For example, there appears to be a need for cohesive family identities, as differing views between adolescents and families of racial identities were associated with delinquent behaviors in South Korean adoptees (Anderson, Lee, Rueter, & Kim, 2015). Parental influence, maternal control, and adolescent engagement were linked to agreement related to shared racial realities and the acknowledgement of differences (Anderson, Rueter, & Lee, 2015).

Individuals who were internationally transracially adopted and experienced high levels of preparation against bias by parents reported lower levels of depressive and externalizing symptoms when compared with individuals who had low levels of preparation (Schires et al. 2020). In contrast, for individuals who are internationally adopted, a moderate level of ethnic identity appears linked to positive self-esteem; a curvilinear relationship was found where too little and too much information about ethnic identity had negative impacts on self-esteem (Mohanty, 2015, p. 35). Although outcomes have not been empirically tested, white parents’ discourses to their children who are transracially adopted appear to be divided along the parent’s own developmental level in white identity formation between “colorblindness” and “race consciousness” (Goar, Davis, & Manago, 2017, p. 347; Helms, 1997). Strict adherence to these extremes transforms into “discursive entwinement,” when parents may at times be colorblind and, in another instance, be race conscious (Goar, et al., 2017, p. 347).

Merging Models of Adoption and Racial/Ethnic Identities
Longitudinal analysis and data from multiple sources offer insight into the complexities of both adoption and racial/ethnic identity formation. Negative behavioral and psychosocial outcomes have been extensively studied in a Swedish cohort of people with international adoptee histories, paired with a paucity of work examining the positive or protective nature of these family bonds (Bråbäck, Vogt, & Hjern, 2011; Hjern et al., 2020; Söderström et al., 2012). In another example of longitudinal data, Hu and colleagues (2017) found that parental and peer influences on identity formation for individuals adopted from Korea differed by time point, with parental ethnic socialization decreasing as the individual reached adolescence; and informant, with parents reporting higher levels of ethnic socialization than adolescents. Most recently, Pinderhughes, Matthews, Zhang, and Scott (2021) propose a new model, in which transactions at the levels of the family are taken into consideration: parent, child/adoptee, and family as a whole. This schema may provide an understanding of how parents provide adoption and racial-ethnic socialization as opposed to only studying such variables as family communication or child development (Pinderhughes et al., 2021). Since the currently published literature indicates that transracially adopted people are at risk for negative behavioral and psychosocial outcomes, the contemporary work of nurses to address health equity and reduce health disparities extends to this special population.

Principles of Trauma-Informed Care

With these milestones in mind and with the unique family dynamics surrounding those who have been transracially adopted, trauma-informed nursing care takes on a specificity that can promote healing (Table 4). Nurses can approach patients with an adoption history utilizing the six principles of a trauma-informed approach: 1) safety; 2) trustworthiness and transparency; 3) peer support; 4) collaboration and mutuality; 5) empowerment, voice and choice; and 6) cultural, historical, and gender issues (SAMHSA, 2014). Examples in Table 4 relate to racial identity formation in adolescence and older. Adoptive racial identity is known to change and emerge across the lifespan from coherence with the parents who raised the child to a more personally formed, externally validated by physical appearance, or chosen identity (Evan B. Donaldson Institute, 2008).

Table 4. Six Principles of a Trauma-Informed Approach for Nurses Caring for People Who are Transracially Adopted

(SAMHSA, 2014)

With a trauma-informed approach at the individual level, nurses are in a key position to identify and mitigate health disparities for those who are transracially adopted with strategies that target the interpersonal, community, and societal level.

Health Disparities and Future Improvements

The research framework of the National Institute on Minority Health and Health Disparities [NIMHD] (2017) is an organizational mental model that can be applied to conceptualize empirical evidence needed to support health equity and equality for individuals who are transracially adopted, and their birth/first and adoptive families (see Figure). Longitudinal studies are needed to simultaneously examine both racial and adoptive identities; strong links to domains of influence; and corresponding levels of influence (e.g., individual, interpersonal, community, society). Using such a framework, researchers can grasp not only how other work answers empirical questions by domain and level of influence, but how investigations can be situated into existing scientific knowledge. Nurses at all levels of practice can use the framework as a shared mental model (Castner, 2021) to consider areas of practice improvement, quality improvement, professional development, leaderships, and scholarship to better understand and eliminate health disparities for patients with transracial adoption histories.

Figure. Research Framework for Minority Health

Figure 1.

[View full size]

Figure Note: (NIMHD, 2017) (Reproduced with permission as part of the public domain.)

Conclusion

What is in the best interest of the child changes, influenced by history, federal law, societal ideology, individuals’ intersectionality, and hegemonic factors.In several, if not most, of the laws, empirical research, and position statements on adoption, the best interest of the child is an often-cited principle. However, these norms have been historically defined through the socio-economic, education, and physical resource valued lens of predominantly European descendant decision-makers in North America. What is in the best interest of the child changes, influenced by history, federal law, societal ideology, individuals’ intersectionality, and hegemonic factors. As policy and laws were written, amended, and changed, the adoption community and other stakeholders began to broaden this question in the context of transracial adoption to include the racial and ethnic socialization and education related to discrimination. When removed from the biological family home, the child’s best interest should be balanced; this question must consider racial and ethnic identity formation and foster/adoptive family placement.

Biological and first family support and resources, as prevention of out-of-home placement and supported by the FFPSA, creates a promising and ongoing strategy to reform transracial adoption practices and targeted nursing interventions. Taken as a whole, the adoption context itself carries bias and stigma and these phenomena are irretrievably intertwined with identity formation for those who are transracially adopted. Culturally relevant and holistic nursing care includes competence and understanding of issues facing people with a history of adoption. Applying a trauma-informed approach to nursing care of these individuals promises to support improved psychosocial; academic or occupational; and health outcomes as we continue to develop further research evidence on health disparities and effective interventions for this population.

Funding and Acknowledgment: Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R43MD017188. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Authors

Jessica Castner, PhD, RN-BC, FAEN, FAAN
Email: jcastner@castnerincorp.com
ORCID ID: 0000-0001-9889-3844

Dr. Castner is the Editor-in-Chief of the Journal of Emergency Nursing and President and Principal of Castner Incorporated, a research institute designed to provide a nursing lens on advanced data analytics, scientific dissemination, and organizational change and development. Dr. Castner’s primary research interest focus is environmental determinants of health and emergency outcomes and care.

Karen J. Foli, PhD, RN, ANEF, FAAN
Email: kfoli@purdue.edu
ORCID ID: 0000-0002-9510-4800

Dr. Foli’s work is bound together by the lens of psychological trauma. With this theme, she builds theory and conducts investigations surrounding parental postadoption depression; relationships between trauma and substance use in nurses; and nurses’ trauma and cognitive control. As a nurse theorist, Dr. Foli conceptualized and disseminated two theories: a Middle Range Theory of Parental Postadoption Depression and a Middle Range Theory of Nurses’ Psychological Trauma. She is also the author of Nursing Care of Adoption and Kinship Families: A Clinical Guide for Advanced Practice Nurses and is co-author of The Influence of Psychological Trauma in Nursing (2019). This book received two first place Wolters Kluwer, Health, and the American Journal of Nursing Book of the Year Awards 2019 for psychiatric/mental health nursing and nursing education. Dr. Foli is an associate professor at the School of Nursing, Purdue University.