Children’s nurse creates simulation lab for parents of fragile kids

Sarah Herold teaches caregivers how to clean feeding tubes, care for patients who need extra help

For Sarah Herold, her dream of creating a family simulation lab at Children’s Healthcare of Atlanta at Scottish Rite has already yielded at least one amazing result — helping a mom and dad have the expertise and confidence needed to save their medically fragile daughter’s life.

A nurse and discharge coordinator in the technology-dependent ICU at Children’s, Herold has worked with babies born prematurely or with congenital abnormalities. When these infants are ready to be discharged, their caregivers need to be proficient in using specialized medical equipment and monitoring devices.

Herold worked at patients’ bedsides in her unit for about 15 years and realized the limitations of being able to prepare caregivers for their at-home role.

From nurses being called away during instruction to the hospital-grade equipment being different from what families would have at home, the previous system had room for improvement.

“I just kept seeing repeated barriers,” Herold said, and she was inspired to find a better way to give caregivers the information they need.

“It completely changed the way that I look at my job. There were so many pieces in preparing these families,” she explained. “There needed to be someone to devise a cohesive plan for them.

“The families I work with are being tasked with basically taking home an ICU, and we are tasked with helping these parents become caregivers.”

Herold met with a nurse scientist who has a doctorate in research, and together they looked at the best methods of teaching and how this differs from what the hospital was doing. They came to the conclusion that caregivers needed to be in a lab space where they could have plenty of time to ask questions and be able to work on a mannequin they don’t need to be concerned about hurting.

The plan started with a mobile education cart, and Herold wrote a proposal for space and funding.

“It just snowballed from there,” she said.

Realizing she couldn’t do the rest of the project on her own, she assembled a team of RNs to help choose what their Family Simulation Lab needed. The team also sought input from caregivers whose children were previously in the hospital to determine the type of help they needed.

When designing the space for the lab, they wanted to create an atmosphere that felt like home, since that’s where the care would be provided. So they shopped at stores like Walmart and Ikea to put together dressers that could be used to store medical supplies. To further the home-like atmosphere, the lab has softer lighting instead of the usual fluorescent lighting used in hospitals.

And to serve as inspiration, the team included pictures of children who had been patients in the unit, showing them out and about, including some who are now grown and no longer need their tubes. The photos are intended to show caregivers their role isn’t a life sentence that means they’ll never be able to leave their homes, Herold explained.

Caregivers have been a little nervous about the lab initially, she added, but they all said they love it.

“They can practice all they want and mess up all they want where there’s no one to see them,” she explained. More important, their child isn’t in danger as they learn.

“It’s like the culmination of my career with these patients and families. It’s something I’ve always dreamed about but didn’t think was achievable.”

Herold cites others who played a strong role in the creation and ongoing success of the lab, including the hospital’s leadership and partners.

“It was my dream, but I couldn’t do it without everyone,” she said.

In 2023, the lab helped 37 caregivers prepare for life at home, and as more families use the space and training, Herold and her team expect hospital stays to be shortened and unplanned readmissions to be reduced.

For one family, the lab has already made all the difference to them and their young daughter. Abigail Sophia Lundy was born Nov. 16, 2022, even though she wasn’t expected until March 2023. As a result, she weighed just 1 pound and stayed in the hospital for 285 days. During that time, she was transferred to Children’s, and her parents, Jessica and Michael Lundy, were one of the first families to use the lab. She came home from the hospital with tracheostomy and feeding tubes.

The Douglasville family faced a life-threatening emergency just a month or two after their daughter was discharged when she had a mucous plug that couldn’t get through her trach. After calling 911, they were able to clear the plug on their own before help arrived.

“Because the simulation lab walked us through these scenarios and gave us a lot of written materials, thank God we knew what to do, because she could’ve died,” Jessica Lundy said. They said they never panicked because they received the training they needed to care for their daughter with confidence.

Even the EMS team was impressed with what they had done, she said.

“I am forever grateful for CHOA, for the (technology-dependent ICU) in general and for the sim lab,” Jessica Lundy said. “Just the whole staff there, it was just a blessing.”

Caregivers need that type of intimate environment and expert help, she added.

The family has been guided by the lab in other ways, as well. They organize their supplies in a dresser just the way it’s shown in the lab, and they were inspired by photos of former patients enjoying their lives.

In particular, a photo of a little boy going on a cruise helped them realize what was possible. So recently they took 1-year-old Abigail on a trip to the Georgia Aquarium, which the little girl, who’s thriving now, loved.

“I think it’s important to show other families that this is not the end for you,” she said, referring to the idea that families will be stuck inside at home for the rest of their lives. “Your life isn’t over.”