“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 Nurse Anesthesiology residents pay the highest tuition in the college of nursing. It’s another way for me to support them during the program.  They need all the help they can get, because of the rigors of the program, they cannot work to support themselves or their families," ~ Kristie Hoch , DNP, CRNA, Associate Clinical Professor, Program Administrator

The funding criteria dictates that those who receive a portion of the grant must complete a rural or medically underserved community clinical rotation, which is fitting, Dr. Hoch says, because the nurse anesthesiology specialty covers 80% of rural access to care across the country. “In addition to the various training that we will comply with for the grant, we bring them in for simulation labs to complete different modules preparing them for this type of independent practice,” Dr. Hoch says.

We have attained the HRSA grant since the inception of the program, and it requires various levels of education a training to apply and meet the standards of the grant. With the previous grant, NARs were required to complete modules on opioid free anesthesia and the various medications for multi-modal pain management in addition to peripheral nerve blocks to enhance pain management and decrease opioid usage during anesthesia.  They also received substance use disorder training. The new HRSA grant will help train NARs the impact Advanced Practice Nurses have on social determinants of health. Part of the funding will also be used to provide further Diversity, Equity and Inclusion training.  “We are proud of the diversity in our program,” Dr. Hoch says. “Currently, among our three cohorts we are at 50%. As Vice President Kamala Harris stated, “Our unity is our strength, and our diversity is our power.”  You must have a workforce that represents your community.”

Obtaining the HRSA funding is an arduous process, but Dr. Hoch points out that Nurse Anesthesiology residents truly deserve it because they’re ineligible for other graduate medical education funding because they are not physicians. It’s an unfair paradigm, she says, “Because we are their anesthesia providers in 80% of rural America.  We provide access to care that many would not receive without us. That’s why I do it: to support them. I love my profession and I hope that I instill that passion in them during my limited time with them in their program.”

A native Tucsonan, Grijalva went to Sunnyside High School. Growing up, he was inspired by the examples of the nurses that cared for his parents when they required hospital care. “Seeing nurses take care of my parents helped me develop an appreciation for them,” he says, noting that this admiration inspired him to want to give back to his community the way those nurses supported his parents. Currently a UArizona pre-nursing student with a minor in public health, Grijalva is taking part in this year’s ANIE Summer Intensive to better prepare him for his future nursing studies.

What inspired your interest in nursing?

I have a lot of experience in hospital environments, which helped me develop a passion for caring for others. When my mother gets out of the hospital, she needs care at home, so I’ve developed a passion for caring for her. But whether it’s my mother or anyone else, I’ll still treat them the same, because it’s always been a love for me to help people and care for others.

Tell us about your experience serving vulnerable populations in the form of fostering infants and children?

My mother has been a foster parent for about 18 years. Since I was born, she’s always gotten new kids, particularly ones whose mother’s abused drugs during pregnancy. They often had issues with breathing and other problems. It’s sad to see, but over time you develop an appreciation for doing something really good for them. Even though we don’t keep the baby, we do make an impact. We feel like we’ve done enough for them to live a healthy life.

Tell us about your experience in the ANIE Summer Intensive.

In the program, we learn what students would learn in their first semester of nursing school. We get a little brief overview, and we volunteer in specific clinical sites to prepare ourselves and learn skills we can use while we’re in there. I also am retaking some courses right now to freshen up on some skills before I hopefully get accepted into the BSN program.

What attracted you to UArizona Nursing?

The first thing is, it’s in my area. I love Tucson and I want to be here my whole life. Secondly, I’ve always dreamed of attending the University of Arizona and I’ve always heard amazing things about the nursing program.

How did you get involved in the ANIE program?

It was through student-run club called Professional Achievements in Nursing (PAIN) that helps pre-nursing students learn more about the program. They had a presentation about ANIE and one of the things that attracted me was the way they provide diversity and inclusion for people you don’t usually find in nursing school. That’s really nice because it’s hard to do school when there aren’t people who look like you or who don’t have the same background as you.

How’s the experience going?

It’s amazing. It’s definitely a summer intensive, but it’s really nice getting involved with other students. I love getting information from inside the nursing program. We’re not only learning about what they’re going to expect, but also about the clinical experience. It’s been a big blessing for me, because I was in a Certified Nursing Assistant program during COVID, so we didn’t get to go out do clinicals. ANIE gives me the opportunity to experience the clinicals that I missed.

What are your hopes for the future?

I want to work as a registered nurse, but after that I want to give back to my community as much as I can because they’re the ones that helped me become the person that I am today. I have to give a part of me because I wouldn’t be here without that support system. I live in a low-income area where people I went to school with don’t really think about going to college. I want to get involved with that type of community and tell them ‘College might be tough but it’s definitely something you should experience.’ I also want to get involved with the health care system in a low-tech, low-income area where people may not be able to afford insurance, or areas where they might not be supported in health.

Born and raised in Tucson, Samantha Chai’s mother is Mexican and her father is Chinese American. About to enter her senior year, Chai’s BSN cohort is expected to graduate in December 2024. She knew from a young age that her purpose in life was to help people. “I didn’t know how I was going to do that, but I just felt so strongly about that,” she says. “Some very strong female powerhouses in my life guided me to the idea of nursing.” She finds inspiration and challenge through the UArizona Nursing program and is passionate about furthering her goal of giving everything she can to her patients.

What piqued your interest in UArizona Nursing?

People always say Wildcat Nurses are a very special breed of nurses. I grew up here, so in the times that I had to go to the hospital I would talk to my nurses and a lot of them were Wildcat Nurses. I had such wonderful experiences, so I think that’s what really drove me. If I could be of service the way they were of service to me, that would be so special.

How did you get involved in ANIE?

I got an email from an advisor about ANIE applications being accepted if you met certain requirements, so I signed up. I honestly didn’t know what I was getting myself into, but it truly has been a life-changing experience in so many ways, and given me so many exciting opportunities.

What have been your favorite parts of the program?

The biggest blessing I’ve gotten is the friendships, the support systems. Every single person I started this program with is truly my best friend. They are the people that have gotten me through getting into nursing school, being in nursing school. It’s such a beautiful, caring space.

Tell us about your experience in the ANIE Summer Intensive.

This is my third summer intensive. It lives up to the name as far as being intensive. There are various types of learning that cater to the experience of a nurse as a whole but also focus on community health. We’re focusing on a self-care approach for modalities and methods and learning about alternative medicines and how those work with western medicine. We also have a critical thinking class that helps facilitate a community of friendship amongst the peers within the program.

And we have these really cool clinical experiences at facilities like Hacienda at the River, which is a nursing care home. We got to go into a memory care unit and get patient-to-patient interactions. Yesterday I went to a Banner Intensive Care Unit -- it was a special experience, because technically I haven’t learned the ICU protocol yet. That comes in third semester, but being able get these experiences is such a once-in-a-lifetime opportunity.

We’re also able to go on trips. Next week, for example, we’re going to Flagstaff for the Regional Health Conferences. We’re given a lot of opportunities and knowledge in these different types of classes that we wouldn’t be able to get in a traditional setting. It’s special, too, that many of us are the people who are representing the underrepresented communities. Being the ones who have power speaking up for our people and having knowledge of different types of modalities, and being the type of nurse who will stick up for a patient if there’s a language barrier, or a cultural barrier. The ANIE program does a really good job of making us feel like we belong and making us feel not only that it’s our responsibility but our gift of being able to share what we know with others.

What are your plans for the future?

I’m such an open book when it comes to my future. What drives me is patient-to-patient connection. It’s funny, my mom is a kindergarten teacher on the south side at a Title One school, and she has such an impact on her community because she speaks the language, and she understands the culture. I’ve been so lucky to see that.  I’m really inspired by the way she’s able to be somebody in her community that has done so much good and made such an impact on these children’s lives, so I would love to do something to emulate that – to be the best nurse I can be.

A first-generation college student hailing originally from Phoenix, Andrea Acero is about to enter her third semester in the UArizona Nursing BSN program. “The opportunities that ANIE brought were intriguing to me because, being a first-generation student, no one in either of my extended families has any experience in health care,” she says. “I’m the first one going into a medical field.” Acero’s first Summer Intensives were marred by the onset of COVID-19, forcing her to attend virtually, but she has prized her in-person experiences since then. She has learned clinical skills, physical assessments, medical terminology, and more, all of which have better prepared her for her future career.

What inspired your interest in nursing?

My parents were both immigrants, so I was aware of their experiences not having their own representation or hearing stories from other people in our community about distrusting health care providers due to not seeing a similarity in the sense of community overall in health care. But I think what truly inspired me was my experience volunteering in Phoenix at St. Joseph’s Hospital, where there was a bilingual nurse. I thought that was interesting because I had never been exposed to that before. I’m Spanish speaking as well, so seeing how much that impacted the patient made me realize that’s how I would be able to make an impact within my own community.

How did you get involved in the ANIE program?

I had heard about ANIE the summer before my freshman year. Emails were sent to all the students that talked about an opportunity for first-generation college students or those identifying as of Hispanic descent or being from rural communities, and so I thought, ‘Okay, I fit within this program.’ I saw it as an opportunity to explore in pre-rec to see if this was truly something that would be a good fit for me. I applied, and then after some interviews, I was introduced into the program.

Tell us about your experience in the summer intensives?

We’ve taken classes in medical terminology, and we’ve built strong critical thinking with our professors. Overall, it was a great way to familiarize ourselves with some of the faculty before going into the college.

The second summer we were finally able to be in person, which was great. We were able to learn about physical assessment as well as skills that would help us ease the transition of first semester. We also attended a conference in Colorado that was great.

What is your biggest takeaway from the ANIE Summer Intensives?

My interest in community health overall. It’s always been something that I’ve leaned toward, but seeing the impact we’ve had in helping others has been great. Over the summers, we’ve been going to smaller clinics in Tucson, like Clinica Amistad which helps those that are underserved and uninsured, as well as Casa Alitas, which is the intake for refugees, where we’ve helped with their transition and provided medical care. My hope is that after receiving my BSN and RN and establishing myself as a nurse I can come back to help the community. Aside from that exposure and all the opportunities, the summer intensives have set a great foundation for friendship. Having others in the group who have similar experiences and backgrounds to me has been great.

What attracted you to the UArizona program?

Two of my siblings graduated from UArizona, so that was one aspect of it, knowing that they had a great experience. I wanted to stay closer to home, and I’d investigated the various state programs, but I knew from speaking to a few nurses how great the program was. I love Tucson, I love the closeness of the community itself, as well as the UArizona campus. So far, it’s been the best choice I made.

Where do you see yourself in the future?

I definitely see myself going higher, whether it’s my DNP or a PhD. A DNP is something I have always thought about – to be able to provide direct service to others as a Family Nurse Practitioner -- but I also think that teaching is something that I’ve always really enjoyed. If I’m able to eventually go back and teach others or become a professor, that would also be something I would really enjoy.