Lyder blazes a busy trail at Nursing School
By Dan Heuchert
Courtney Lyder inhabits what School of Nursing Dean Jeanette Lancaster calls “the gold standard of offices around here.”
It is impeccably neat. The lighting is muted; relaxing classical guitar music plays in the background, and a water garden burbles quietly.
The office, located on an interior hallway on the fifth floor of McLeod Hall, has no windows. “They don’t want me to know when it gets dark outside,” quipped Lyder, the University of Virginia Medical Center Professor of Nursing.
He’s joking, of course. But like most jokes, this one is seeded with a kernel of truth: Only two years after coming to U.Va. from a nine-year stint at Yale University, Lyder may be one of the busiest faculty members on Grounds.
The 39-year-old native of Trinidad & Tobago believes he may be the first black man in the world to hold an endowed nursing chair. As such, he said he feels a special responsibility to maintain a high profile.
Thus, he has taken on the chairmanship of the school’s Department of Acute and Specialty Care, which has 20 full-time and 25 part-time faculty members. He designed and directs the school’s geriatric nurse practitioner program. He plays key roles in both the new Institute for Aging, where he sits on the advisory board, and in a first-of-its-kind, family-centered geriatric unit — run by nurse practitioners — at the Medical Center. He also heads the Nursing School’s diversity committee.
His research into the prevention of pressure ulcers in dark-skinned patients led him to chair a federal panel that revised patient-care guidelines for the nation’s 16,000 nursing homes, and strengthened the penalties for violating them. As a result, he is in great demand as a consultant, both for the nursing home industry and to train state regulators charged with enforcing the new guidelines.
Where some might see a heavy burden, Lyder sees opportunity.
“I think it is an incredible responsibility, because by the very fact that there are so few of us, we are trailblazers,” he said. “Others look to you to set a standard. In many ways, it is a wonderful honor, and I don’t take it lightly.
“I want to show younger black men, younger minorities, that they too can do what I do, and do it better.”
Lyder is known as a dedicated mentor, Lancaster said. “I’ve just seen Courtney take a real interest in people. He wants to help them become all they can become, or thought they could become.”
Randy Jones, who will receive his doctorate this spring, is one who has gained from his help. Lyder, a fellow in the American Academy of Nursing, invited Jones to the academy’s annual meeting last fall and introduced him around.
“It was really a great opportunity for me, and it was all because of him,” Jones said.
Lyder’s life course was set when he came to the United States to live with his grandparents when he was 13. Living with them inspired him to seek a career in caring for seniors.
“When I was going to college I knew I wanted to do a degree in gerontology,” he said. He enrolled in a joint degree program that allowed him to earn bachelor’s degrees in biology and psychology from Beloit (Wisc.) College and in nursing — where he felt he would have the best job prospects — from the Rush University College of Nursing in Chicago. He later added master’s and doctoral degrees in gerontological nursing from Rush.
It was during his graduate career that he signed on as an assistant to a nurse researcher doing work with skin care of older adults, and had his first encounter with a dark-skinned patient with bedsores.
“It really did change my entire career path,” he said. The problem: “For people of color, the early stages of skin breakdown is very difficult to identify,” Lyder said.
The traditional protocol teaches nurses to diagnose potential bedsores, or pressure ulcers, by applying light pressure to reddened areas of the skin and checking to see if the area “blanches,” or turns white. If not, it could indicate a developing ulcer.
That works well for people with lighter skin, but darker skin doesn’t turn red, let alone white. “With the browning of the population, the parameters for melanin-challenged individuals just won’t work,” he said.
As a result, ulcers can go undetected in dark-skinned people until they reach a greater stage of severity, he said. Lyder’s current research is attempting to identify early indicators of potential tissue damage that could be equally effective in identifying potential bedsores in dark-skinned people before they become a problem.
It may not seem like glamorous work, but it has major potential significance. “This little problem seems so simple, but it has so many implications,” he said.
It was that work that led him to join, and ultimately chair, the National Pressure Ulcer Advisory Panel, which revised the nursing home industry standards of care.
“It’s kind of neat — we as nurses talk about leadership and making a difference,” Lyder said. “You can see how something you are doing affects 16,000 nursing homes nationwide. That’s very cool.”
Approximately 18 percent of the approximately 2 million elders in nursing homes are black, he said. Estimates for treating pressure ulcers range from $1.6 billion to $3 billion annually, “and will continue to rise given the aging U.S. population.”
Lyder also is reshaping parts of the Nursing School and Medical Center.
In September, he received a three-year grant to develop a master’s-level geriatric nurse practitioner program. He moved quickly; two students will graduate this spring. “I don’t come to mess around,” he said.
Those graduates may find employment at the U.Va. Medical Center, which is opening a new geriatric unit staffed by nurse practitioners and led by Nursing School professor Kathy Fletcher, the Health System’s director of senior services. Lyder is an important contributor to that effort.
With older patients, the focus is more on function and maintenance, and less on curing, Lyder explained. Physicians will be involved in patient care, but nurse practitioners will provide coverage 24 hours a day, seven days a week.
The patients’ families will be allowed to visit around the clock. “The question is, ‘What does the family need? What does the older adult need?’ Not, ‘What does the staff need?’” said Lyder, who is seeking a grant to evaluate the new approach.
The ultimate goal is a more patient-centered approach to caring for the elderly. Among the other grants Lyder has applied for would further study the use of “smart house technology” to assist in monitoring the elderly at home.
“More and more elders will be aging in place,” he said. “Smart technologies will allow elders greater autonomy and independence to care for themselves at home. The future of elder care lies in advanced, yet simple biomedical technologies informed by nursing.”