Nursing Excellence Fellowship

Caroline Trotter, CPNP-PC/AC, is a pediatric nurse practitioner at the Hemophilia of Georgia Center for Bleeding and Clotting Disorders within Children’s Healthcare of Atlanta and Emory University. She received her Master of Science in Nursing from the University of Alabama at Birmingham and is certified in both primary and acute care.  She has worked within the hemophilia treatment center for almost 5 years and has developed a passion for this population. 

Her research focuses on girls with bleeding disorders and heavy menstrual bleeding. Current projects are aimed at creating a screening and treatment process for Vitamin D deficiency in these patients as well as comparing vitamin D levels across various heavy menstrual bleeding treatment regimens. As there is not currently a vitamin D screening guideline, this research may help identify a gap in care.

Louise Baca, MSN, RN, has over 40 years of healthcare experience, primarily specializing in oncology. She has worked in various settings, including inpatient oncology, outpatient infusion, clinical research, and as a nursing instructor. For the past 14 years, she has served in an administrative role, currently as Senior Director at Maine Medical Center, where she leads the MaineHealth Bleeding Disorders program. Under her leadership, the program has grown significantly, expanding from 2.5 to 15 FTEs and enhancing patient care in Maine and New Hampshire. Louise also serves on several committees, including the Hemophilia Alliance Board of Directors and the New England Regional Executive Committee, and has presented nationally on healthcare topics.

This project is a nurse led project (APNs and RN’s) and focuses solely on developing relationships with nurses and other clinicians in rural areas. As the only HTC in the state, it is the responsibility of the MaineHealth Bleeding Disorder nurses to educate other nurses in rural parts of Maine who will be the first point of contact. This work will create a blueprint for nurses, providing them with comprehensive information and practical ideas that can easily be implemented and assist them in caring for patients living in rural areas. These successful strategies will allow for the sharing of best practices ultimately elevating the standard of nursing care across all HTCs.

I am a Family Nurse Practitioner at the Northwell Hemostasis and Thrombosis Clinic (HTC) trained in Primary Care and then had specialized training in Hemostasis. I anticipate completing a Doctor in Nursing Practice terminal degree in December 2023. I have both clinical and research responsibilities at the HTC and currently serve as Co-Investigator on 6 research studies. I enjoy working on projects such as Health Care Transition, empowering patients to take ownership of their health as they transition from pediatric to adult care. In addition, my passion is in primary care and men's health. I currently serve as the New England regional representative on the National Bleeding Disorder Foundation (NBDF) Nursing Working Group. I also sit on the Research Nurse Board of Directors at Northwell.

A professor and dual certified nurse practitioner in pediatrics and adults.  She completed her PhD in Educational and Organizational Leadership and taught for 10 years specializing in camp nursing, service leadership, physiology, and hematology. Dr. Gaslin periodically works as a camp consultant and legal consultant and publishes the majority of her work in the areas of bleeding disorders, pediatric development, camp nursing, behavioral health, and leadership.

Dr. Gaslin served as the Medical Director at a special needs camp for six years where she directed care for children with chronic disease, disability and life-threatening illness.  She currently serves as a nurse practitioner in a Hemophilia Treatment Center.  She also serves as the Executive Director for the Association of Camp Nursing where she travels to different areas of the US and Canada educating healthcare providers about camp health services and the many benefits for children and adults. She recently (2020) co-authored a textbook:  Camp Nursing; The Basics and Beyond.  Dr Gaslin is passionate about every child having a camp experience and learning that they can achieve great things in life.

This research project will illustrate the improvements to joint range of motion and hospital utilization (which includes emergency room visits, hospital admissions, and central line infections) in persons with hemophilia A (with and without inhibitors) who switched to emicizumab for bleeding prevention.

People with bleeding disorders are often connected to and with various community members such as local and national foundations/associations, their home health company, nurses , pharmaceutical representatives, etc. While people are often encouraged to wear medic alert ID, they do not know anyone in the EMS system who may be caring for them in case of an emergency. Through this project, EMS providers will receive education regarding bleeding disorders and the treatment required in an emergency. This project will seek to connect the HTC's with the EMS systems locally and regionally to coordinate the education with the EMS professionals to provide care.

Pediatric pain, especially in the hemophilia population, is under-recognized and under-treated. Barriers to adequate treatment include lack of knowledge, variability of practice, and outmoded beliefs. All of these factors lead to a culture of slow to no change in practice patterns. Health care providers need current, state-ofthe- art education and tools to assist them in developing the skills required to assess and manage pain in children. Children are often given minimal or no analgesia for procedures that would be treated aggressively in adults. Although more is now known about pain management in children, this knowledge has not been widely or effectively translated into routine pediatric clinical practice, including the practice of most HTCs. In the bleeding disorders community, especially for those with hemophilia, children begin to experience frequent pokes secondary to frequent factor infusions and blood draws at an early age. Depending on the severity of their disorder, they may experience a poke daily or more frequently. This gives rise to anxiety for the child as well as their parents and other family members. Anticipatory anxiety is not uncommon in this setting. The child and their family often feel as though they have no control over the situation. A distraction box is filled with tools for providers to implement during any procedure involving children. The simple act of distraction (in whatever form) can significantly decrease pain and anxiety for both the child as well as their parent. This box offers multiple methods of distraction and informational videos on techniques. The focus of the Poke Plan is to give control over a painful or anxiety provoking situation back to the parent/child. The simple wallet card quickly educates any provider on how the child best handles the discomfort and anxiety associated with a poke/needlestick. Filling out the card educates the parents on distraction techniques that may be helpful for their child in painful and anxiety provoking situations. To date there have not been any studies done in this population. However centers in Michigan using similar Poke Plans in the general pediatric population include but not necessarily limited too are: Sparrow Hospital in Lansing Michigan, Munson Medical Center in Traverse City, Michigan as well as the University of Michigan Children and Women’s Hospital in Ann Arbor, Michigan.

The project's ultimate goal is to expand nursing knowledge of hemarthrosis/soft-tissue bleeding detection by presenting our HTC's experience with how MSKUS improves accurate diagnosis and guides treatment of bleeding and other pain etiologies. By completing the retrospective data review, we hope that the experience of a large center HTC spanning both adults and pediatrics will be made available. We believe that the current restraints of MSKUS implementation include cost of equipment, operator certification, and quality of interpretation to guide interventions. Therefore, partnering with radiology experts may be helpful for other HTCs around the country when using this modality in the future. Our center's experience will show that collaboration with radiologists for real-time imaging is successful with nursing evaluation and coordination.

The purpose of this project is to request support for the development of a Virtual Reality Environment (VRE) study program for pediatric patients diagnosed with hemophilia. The VRE program proposed was developed and created for children and includes interactive imagery, character avatars and colorful visual environments. This VRE program will be deployed by the child in a clinical setting and is proposed to help decrease, anxiety and needle phobia during intravenous factor infusions. Outcome measures will include an anxiety scale before and after each infusion, collection of biophysiologic data, pain score and visual analogue evaluation. The expected result of this nursing project is to monitor the use of a VRE in the pediatric population with a reduction of fear, anxiety and pain experienced with intravenous factor infusions.

As technology advances and provides electronic tools for enhancing communication by phone and computer, health care providers are finding ways to adapt these tools into patient care. Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care. For patients with hemophilia who experience a bleed in the home setting, telehealth has the potential to help the patient, family, and health care provider assess what is going on and develop the best plan of care, all while the patient stays in the home setting. In this clinical project, we will use the telehealth resources available at our institution to partner with patients and families with severe hemophilia with a high risk of bleeding episode who also have a home computer with a camera and internet access. We want to find out more about how many patients have these home resources, how to use video-conferencing when managing a bleed and what patients, families, and health care staff think about using video conferencing. This will help us plan future research using telehealth video-conferencing for a larger group of hemophilia patients.

Menstrual cycles for females with bleeding disorders can present special challenges not experienced by other girls and women. Having your period can be physically, social and emotionally exhausting. A new web-based application is now available and can be downloaded to your personal mobile device or desktop computer. With this application you can track how long your period lasts, how much you are bleeding, any interventions utilized and how it is affecting your daily life. This is a new web-based application you can download that is free and available to all girls and women with bleeding disorders through their federally funded hemophilia treatment center (HTC).