“Back in 1984, no one seemed to really know what to do for prevention or treatment. I learned if you’ve got a problem,  you can’t make it better until you identify it and start to gather data to know more about the problem. Then you have to figure out how you’re going to manage it," ~ Karen Kennedy-Evans, RN, FNP, APRN-BC

In 2013, she and her husband formed the Dr. James Evans & Karen Kennedy Evans Nursing Foundation, which benefits students in the UArizona program.  “We wanted to help nursing students who were having a hard time paying their tuition,” she says.  At the same time in 2013 they formed the “Kennedy Terminal Ulcer Foundation” which helped nurse aides in long term care (LTC) who wanted to go on to become an LPN or an PNs that wanted to go on to an RN, or RNs to go on to Bachelors or Masters. In 2023, the University of Arizona combined these foundations.

The relationship began in 2002, when she first moved to Tucson. Joan Shaver had recently been named UArizona Nursing’s new dean. Kennedy-Evans, thrilled at having access to a large university and its researchers, called Shaver and said, “You don’t know me, and I don’t know you, but I’m new in town and so are you and I want to come see you. I don’t know how this could work out, but you have a wealth of nurses and researchers here. Maybe we can work together and change the world.”

After graduating from Saint Joseph's Hospital School of Nursing, Fort Wayne, IN, 1970, Kennedy-Evans has gone on to a long and noteworthy career and became the very first Family Nurse Practitioner in Fort Wayne, Indiana in 1974.  She has received such honors from the largest wound conference in the world, SAWC (Symposium on Advanced Wound Care) in 2013 the “Evonne Fowler’s Founders Award, and in 2020 received the  Inaugural Lifetime Achievement Award at their Post Acute Care Symposium. In Tucson, Kennedy-Evans 2008 has been awarded  the Fabulous 50 nurses award and in 2013 received the Most Inspirational Mentor Award from the Tucson Nurses Week Foundation.

In 1983, Kennedy-Evans found herself at the forefront of a new line of wound care research – one that ultimately would lead to a pressure ulcer being named after her: The Kennedy Terminal Ulcer. Now known as the “Kennedy Lesion.”

She was working at a 500-bed Long Term Care (LTC) facility in Fort Wayne, Indiana., the Byron Health Center where She realized that pressure ulcers – now called pressure injuries to skin and underlying tissue resulting from prolonged pressure on the skin – were a problem without a great deal of research behind them. “Back in 1984, no one seemed to really know what to do for prevention or treatment,” she says. During this time, she attended a two-day pressure ulcer and incontinence seminar in hopes of learning more about the problem. “I learned if you’ve got a problem, you can’t  make it better until you identify it and start to gather data to know more about the problem. Then you have to figure out how you’re going to manage it.”  The Byron Health since has named one of the buildings after her called the “Kennedy Crossing.’

Following the conference, Kennedy-Evans started the first skin and wound care team in the United States. She worked with the floor nurses to try to determine the incidence of pressure ulcers among patients. She began by making weekly rounds on every floor with the head nurse of the floor, pharmacist, dietician and nurses’ aides. “We put a committee together and once a week we went around and looked at every pressure ulcer,” she says. “We took pictures of them, and we measured and described them. We made sure they had the right support services, the right nutrition, the right turning schedule and the right medications and treatments, just to see if we could make a difference.”

She and her team started to notice some patients developed pressure injuries that didn’t seem to make sense. The criteria in 1989 was simple: 1. ) There was a sudden onset, often with the nurse exhibiting surprise at its appearance 2.) The ulcer was usually shaped like a pear 3.) it was usually on the sacrum or coccyx, 4) the colors were red, yellow, and black, and 5.) Death is imminent.

As she collected more data, Kennedy-Evans began to see a pattern from ulcer appearance and to time of death. On average, patients who developed these unusual ulcers with a sudden onset died within two weeks to months. “The medical director of our facility, Dr. Stephen Glassley, started calling these wounds ‘Kennedy Terminal lesions,” she says which morphed into “Kennedy Terminal Ulcers.” Based on five and a half years of collected data, she was encouraged to submit an abstract to the very first National Pressure Ulcer Advisory Panel (NPUAP) now known at the National Pressure Injury Panel (NPIAP) conference in Washington DC. to present her observations.

Since then, Kennedy-Evans has seen her work spread, with more doctors and nurses attending pressure injury conferences, as well as a widening network of other researchers. Since she started her research back in 1976, she has seen much positive change. “The federal government is now involved in pressure injuries, as well as doctors, surgeons, vascular surgeons, dieticians, physical therapists,” she says. “Almost every branch of medicine and nursing is involved in some way in pressure injuries.”

One of her proudest achievements is the impact she has had on legal action alleging pressure injuries can be from inferior care as the cause of pressure injuries against LTCs and nurses. Over the years, she has put her skills and research to work in dozens of legal depositions, helping to change the narrative of blame.

“I’ve been on the side that gets blamed most of the time because the majority of my career has been in long-term care,” Kennedy-Evans says. “At the facilities that I have worked at, nurses work so hard. Often, they know more about the patient than the family. They know on what side of the bed they want their slippers; they know how much cream they want in their coffee; they know if they want one or two packs of sugar; they know if they want their toast cut diagonally or horizontally. They notice subtle changes often before others." Seeing nurses being unfairly blamed for a situation beyond their control has been a career-long struggle for her, proving that the ulcer has nothing to do with care and everything to do with the patient’s overall has been her abiding passion.

Pressure injury knowledge and research has evolved, much of it thanks to Kennedy-Evans’ efforts. Most recently, Kennedy-Evans and Dr. Leslie Ritter, PhD RN, Professor Emerita, College of Nursing and colleagues from Indiana, Ohio and New York, undertook research to record pressure injuries in a small study involving several hospital ICU’s.  The study employed a state of the art thermographic imaging system and measures both the visible discoloration and the temperature of the skin. The study showed when measured within 24 hours of intact skin discoloration, there is no skin temperature change compared to normal skin.  The authors hypothesized that presence of visible discoloration but no temperature change may be due to skin microcirculation failure and not due to tissue damage below the skin surface. These findings are in contrast to the damage of pressure injury, which starts at the bone-level and works its way up to the surface and is associated with skin temperature increases (due to inflammation) or temperature decreases (due to ischemia).  In March of 2023, Kennedy-Evans and Dr. Ritter presented their findings at the annual National Pressure Injury Advisory Panel meeting…

“Keep in mind, this is just a small case study but in all cases we got the same  results,” Kennedy-Evans says. “We were very encouraged by this because, if indeed this is true and these studies can be replicated, if the facility has a thermographic device and the picture can be taken in the first 24 hours on onset this would indicate the lesion is not from bad care.”

“The process of earning a PhD is all about learning how to become a scientist, but the University of Arizona offers elective courses that prepare doctoral students for a career in leadership and management,” ~ Lieutenant Colonel Pedro Oblea, PhD, RN

His interest in the project dates to his time at Fort Bragg, when an officer in charge of a deployed unit told him that military nurses were experiencing facial skin breakdown caused by the constant mask requirements. “As a nurse scientist, I was intrigued,” he said. Looking for evidence or gaps in knowledge, he reviewed the literature for possible treatments and clinical practice guidelines to prevent skin breakdown related to wearing N95 respirators. “To my surprise, very few research articles have been published on this topic,” he said. “Epidemiological studies have revealed that healthcare workers who wear N95 masks suffer from acne, facial dermatitis, and pigmentation of the nasal bridge, cheeks, and chin. I decided to write a research grant for possible funding.”

The study – which is scheduled to last until February, 2022 – will employ a non-blinded, randomized, three-period crossover design with two active treatments (faceplate and cream) and a control group. Each study participant will serve as their own control for comparison with the received interventions, eliminating the influence of selection bias. Participants will use the hydrocolloid skin protectant under their N95 masks, a dimethicone cream application, or no hydrocolloid barrier based on the randomization.

“I expect the hydrocolloid skin protectant, which is strong yet thin enough to allow a good seal when donning a N95 respirator, will reduce skin breakdown in the facial area and improve PPE protocol adherence,” Dr. Oblea said, noting that it is still too early to do more than speculate about possible results. 

In his new position as Chief, Center for Nursing Science and Clinical Inquiry at Tripler Army Medical Center, Dr. Oblea has a host of important responsibilities.  The Center has one of the largest military hospitals in the Pacific and falls within Regional Health Command – Pacific, which oversees medical, dental, and public health facilities on the West Coast of the United States as well as in Alaska, Hawaii, Japan, and South Korea. Its operational space spans 36 countries and encompasses more than 4,500 miles across five time zones. Dr. Oblea’s primary responsibility is to provide oversight and facilitation for nursing research and evidence-based practice projects. “I supervise a staff of nurse scientists, doctorally prepared clinical nurse specialists, and research coordinators,” he said, adding that he oversees and engages in research and evidence-based practice execution, mentorship, and education. “I also provide consultations and decision support. Ultimately, I encourage and establish collaborations with military and civilian university students and staff while also participating in organizational development initiatives.”

Dr. Oblea cites the mentorship and guidance he received as a PhD student at UArizona Nursing as providing inspiration for his leadership role. “I still ask my faculty advisor and dissertation chair, Dr. Terry A. Badger, for advice when I need to make decisions and fine-tune research questions,” he said. “The process of earning a PhD is all about learning how to become a scientist, but the University of Arizona offers elective courses that prepare doctoral students for a career in leadership and management.”

Dr. Oblea’s magnanimous view of his responsibilities are inspiring and embody the qualities that distinguish so many of our Wildcat Nurses. “When I was promoted to Lieutenant Colonel, my focus changed from ‘self-serving’ to ‘service to others,’ meaning that I no longer put my own career first, but instead focused on how to help others achieve their goals, accomplish their mission, and perform better in their jobs,” he said. “I believe that, when my soldiers excel in their jobs and succeed in their missions, it will reflect my leadership and management style in the long run.”