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Cedars-Sinai Blog

Compassion: The Key to the Art of Nursing

Karen Silva teaches nurses at Cedars-Sinai how to work with vulnerable patients—working side-by-side with them at patient’s bedside.

Karen Silva remembers wading through the swollen waters of the Belem River where she grew up in Curitiba, Brazil, working her way to the homes of elderly neighbors to help them stack sandbags in their doorways.

She went on to pursue law school and journalism, but at 19, she again wanted that feeling she had helping her neighbors. She decided she wanted to become a nurse.

"I knew nursing would give me the pleasure of daily altruistic acts," says Silva, an education program coordinator at Cedars-Sinai.


"Compassion is like an exercise. The more you do it, the more intrinsic rewards you receive."


In a way, she nurses other nurses: Silva teaches them how to work with especially vulnerable patients. She works side-by-side with them at the bedsides of patients, troubleshooting ways to prevent falls and to provide the best care. She is called in when grief-stricken families need additional support.

Silva has served as a nurse for nearly 30 years. Besides her RN degree, she holds a doctorate. Most of her career has been spent in psychiatric nursing and forensic nursing, which brought her to the side of victims of crime and violence—in the hospital and sometimes in the courtroom.

Practicing Compassion

In every nursing role, she’s relied on compassion.

"Compassion is like an exercise," she says. "The more you do it, the more intrinsic rewards you receive. The same areas in the brain that are related to pleasure are also connected to compassion. It's why even when we're on the verge of burnout, it's very hard to ever leave nursing. It's addictive."

She explains this bit of physiology to nurses under her care, training them to be aware of empathy fatigue and the toll it can take on their bodies and their work.


"You mustn't leave compassion behind. You're not just a laborer."


Nursing is mentally, emotionally, and physically demanding work, and the profession has long been considered one of the most stressful according to research from the Centers for Disease Control. Meeting the needs of multiple patients, helping their families, taking care of patients who are very ill and those who are dying can be draining. At the same time, nurses balance the administrative duties of their jobs. The long hours and physical and psychological demands of the work can take a toll.

This is where Silva believes teaching nurses to practice compassion with patients, coworkers, and themselves can play a role in easing the factors that contribute to burn-out.

"That's the art of nursing—sometimes, because of all the demands of the work, you can leave that behind, but you mustn't. You're not just a laborer."



Compassion in Action

Silva counsels fellow nurses in the art of their profession while also forwarding the science that drives day-to-day nursing practice. She dives deep into data to identify trends that can help improve patient care and patient safety.


The number of falls at the hospital decreased by 70%.


Compassion becomes the driving force of the interactions in nursing.

One of her major projects at Cedars-Sinai addresses fall prevention. She scoured data for 2 years, examining which patients were falling at the hospital, what times of day, what treatments they received—analyzing every factor that might lead to a fall. At the end of it, she compiled 5 pages of risk factors for falls.

She and her colleagues mined the data for the root causes of falls and worked on prevention plans. The result: The number of falls at the hospital decreased by 70%.

They noticed a pattern of patients falling because of muscle weakness, so nurses started exercising patients in their beds. They encouraged them to get out of bed to use the bathroom, to keep moving with assistance to build and maintain their strength.

Sometimes, the data delivered surprises: Who was at the highest risk of falling? Younger patients with the fewest risk factors, simply because they tend to be the least likely to believe they could fall.


"We need to take care of our people so they can continue to give care with empathy and compassion in everything they do."


To address this problem, Silva brought nurses into the skills lab where she played the role of a reticent patient, challenging nurses to convince her to accept their help.

Again, compassion became the driving force of the interaction: Nurses were more successful when they took time to understand what patients really wanted—independence.

"We have to explain that we're not trying to take anyone's independence away—we're trying to preserve it by preventing the fall," she says.

Compassion with Each Other

Silva's aim in her work is to give a better experience to patients and also to the nurses who take care of them.

Nursing is demanding work every day and Silva says compassion can go a long way when practiced with patients and with coworkers. She works to give nurses the skills, care, nurturing, and compassion they need to come into every shift ready to meet its challenges and give the patients their very best—day after day.

"We need to take care of our people as well," Silva says, "so they can continue to give care with empathy and compassion in everything they do."

A nurse for 30 years, in addition to an RN degree, Silva holds a doctorate and has spent most of her career in psychiatric and forensic nursing.