Sister Marie Simone Roach's contributions to nursing scholarship and practice

Sister Marie Simone Roach

A number of prominent nursing theorists have been an influential force in improving nursing practice over the years, with Sister Marie Simone Roach being among them. Sister Roach is best known for her so-called "six C's" of nursing care: Compassion, Competence, Confidence, Conscience, Commitment, and Comportment. Her work has been absorbed into the mainstream of nursing theory over the years and her contributions to nursing practice have been significant. This paper examines the contributions made by Sister Roach to the body of nursing scholarship for the improvement of nursing practice, her contributions to the body of nursing scholarship for the improvement of healthcare and how this nurse ethicists can inform nursing research for the nurse practitioner.

Review and Discussion

Biography of Sister Marie Simone Roach

According to her official biography, Sister Marie Simone Roach was raised in a Roman Catholic family with a number of siblings in a coal mining area of Cape Breton, Nova Scotia, Canada (Sister M. Roach biography, 2011). Although no date for her birth is provided, her official biography reports that following graduation from high school, Sister Roach completed a nursing diploma program at St. Joseph's School of Nursing, Glace Bay, Nova Scotia. Upon completion of a year of nursing practice, Sister Roach joined the Sisters of St. Martha, Antigonish, Nova Scotia, working in a number of clinical areas as well as providing instruction in regional Schools of Nursing (Sister M. Roach biography, 2011).

Thereafter, Sister Roach attained a nursing undergraduate degree at St. Francis Xavier University, Antigonish as well as completing graduate study at University of Toronto, Boston University, and the Catholic University of America (Sister M. Roach biography, 2011). At the Catholic University of America, Sister Roach completed a doctoral program with a major in Philosophical Foundations of Education in 1970 (Sister M. Roach biography, 2011). Her post-graduate work was not finished, though, and Sister Roach went on to complete 2 years of post-doctoral studies (one year at Harvard Divinity School [Ethics], and one year as Reader at Regis College, Toronto). During these studies, Sister Roach also managed to complete the second revised edition of her book on caring (Sister M. Roach biography, 2011). Although the concept of caring has remained a central focus of Sister Roach's teachings, she did not begin her formal study of caring until 1970 when she was Chair of the Department of Nursing, St. Francis Xavier University (Sister M. Roach biography, 2011).

Sister Roach was also a key actor in developing a code of ethics for the nursing profession. For instance, in 1955, the Canadian Nurses' Association adopted its first Code of Ethics, based on a code developed by the International Council of Nurses (ICN) (Johnstone, 1999). This Code of Ethics, as revised over the years, remains an influential resource that provided a useful framework for nurses in their ethical decision making until the 1970s (Johnstone, 1999). Over time, though, there were increasing calls for an ethical code that was specifically suited to the unique healthcare situation in Canada, and these issues were addressed at the CNA's 1978 Annual Meeting when the creation of a new national code was made a priority, and in 1979, Sister Simone Roach was designated as project director for this initiative (Johnstone, 1999).

Contributions to the body of nursing scholarship for the improvement of nursing practice

According to McKenna (1997), during the 1990s, a number of healthcare professionals began work to expand and build on prior work of nurse theorists in an effort to keep nursing scholarship timely and informed for the 21st century. These efforts were built on the foundation established by the previous theories of caring put forward by Sister Simone Roach (McKenna, 1997). Based on her initial research, Sister Roach sought to answer the question, "What is a nurse doing when he or she is caring?" In response to this foundational question, Sister Roach formulated five categories that became known as the "Five C's" (which were later expanded by an addition): Compassion, Competence, Confidence, Conscience, Commitment, Comportment (included later.)

The body of nursing scholarship is illuminated by Sister Roach's reflections on these components of caring in all her writings (Sister M. Roach biography, 2011). These fundamental elements of nursing are defined as follows:

1. Compassion: Experiencing the feelings of the client and family;l

2. Competence: Knowing the condition of the client, how to treat, and what is available to the client and family;

3. Confidence: Fostering mutual respect and a trusting nurse-client relationship;

4. Conscience: Applying ethical and legal standards of practice and maintaining professional boundaries;

5. Commitment: Being available for whatever is needed by the client/family; and,

6. Comportment: Projecting a professional image (Concepts and definitions, 2011).

While the Six C's as attributes of caring have an important practical application, this aspect of Sister Roach's research did not fully address a more fundamental ontological question, "What is Caring, in itself?" Reflection on this question led to the insight, "caring is the human mode of being." We care, not because we are nurses, physicians, social workers, parents, etc.; we care because we are human beings. We differ in how we care, not in that we care. Caring is not unique to nursing or even to the caring professions; it is a primary characteristic of being human. Further reflections in Caring from the Heart, noted above, examined the convergence of caring and spirituality. Sister Roach's research, inspired by The Universe Story (Swimme, Berry, 1992) and other writings, pursued the more universal call of care as a "child of the universe." This is an exciting, ever-expanding development moved by rapid developments in science and technology (Sister M. Roach biography, 2011).

Contributions to the body of nursing scholarship for the improvement of health care

Sister Roach has lectured internationally, with presentations in Australia, Bangkok, Finland, Cambridge (England), Russia, Sterling (Scotland), Canada and the U.S. She shares her work with the expectation that it will be helpful to students teachers and practitioners alike, and that application will continue to be made at all levels of health care (Sister M. Roach, 2011).

Among her published work, the following are regarded as being foundational:

1. 1984. Caring: The Human Mode of Being, Implications for Nursing, a Monograph. Faculty of Nursing, University of Toronto.

2. 1987. The Human Act of Caring, A Blueprint for the Health Professions. Ottawa, Canadian Healthcare Association Press.

3. 1997. Caring From the Heart: The Convergence of Caring and Spirituality. Mahwah, NJ: Paulist Press. (a compilation of chapters by 13 authors, each relating to a theme but with a unique focus)

4. 2002. Caring, the Human Mode of Being: A Blueprint for the Health Professions (2nd rev. ed.). Ottawa: Canadian Healthcare Association Press (ISBN 1-896151-44-2) (Sister M. Simone Roach Archives 2011)

Clearly, the essence of the contributions made by Sister Roach is her emphasis on caring. For instance, in her text, Caring from the Heart, Roach (1997) emphasizes that, "Caring from the heart is a response from the core of each person, a response to the call to be human. It is revealed uniquely in the established patterns of different cultures and manifested by all who share a common human journey. . . . Caring is made visible in the relationship of doctor and patient, as one human being facilitates the healing of another who has been violated and outraged" (p. 5). The role played by nurses in this effort is also made clear by Sister Roach who stresses the need for healthcare practitioners to develop a therapeutic relationship with their patients and use this rapport to promote improved clinical outcomes (Roach, 1997).

In her text, The Human Act of Caring. A Blueprint for the Health Professions (1987), Sister Roach emphasizes the need for healthcare professionals to remain flexible in a rapidly changing world. In this regard, Shields (2009) reports that, "As an experienced nurse-educator, Sister Roach sees the need to explore a philosophy of caring because of what she describes as a 'value crisis in Western civilization.' This 'value shift' is seen as militating against the expression of caring in individuals as well as in societies. The main concern of the book, however, is how this phenomenon has affected those who choose to practice in the health care professions" (p. 37).

How this nurse ethicist can inform nursing research for the nurse practitioner

Nurse practitioners have become an integral part of the healthcare team in recent years, and their role has expanded in many countries to include prescriptive authority as well. In addition, innovations in technology and healthcare in recent years have created a very real need for timely and relevant nursing ethics. Although these changes have provided improved healthcare outcomes, there remains a need for the nursing profession to be on the front lines of the delivery of these services, and the tenets of Sister Roach can be viewed as foundational to this need. As McKenna points out, "Theory does not develop from empirics alone. Theories evolve from ideas, and ideas evolve from hunches, personal experiences, insights, inspirations, intuition and the work and experience of others. The influence of ethics, aesthetics and personal knowing can be detected in the work of those theorists who focus on caring such as Sister Roach" (1997, p. 37). To her enduring credit, the original research and contributions made by Sister Roach have been highly influential in this regard. For example, according to Van Hooft (2004), "Nursing is not the only health care profession for which caring is a central virtue. I would suggest that the fundamental virtue in the practice of all the health care professions is that of caring [and] the work of Simone Roach has now been absorbed into the mainstream of nursing studies" (p. 4).

The Code of Ethics on which Sister Roach was project director has also become the guide to bioethical decision making in the nursing profession. According to Johnstone (1999), The Code of Ethics has become "a living document," and provides the foundation for nursing ethicists. Moreover, steps have been taken to ensure that the Code remains relevant and timely, with provisions having been made for review at least every five years to keep it responsive to changing needs and values, both within the nursing profession as well as the larger society in which health care services are provided. "Change is inevitable; however, certain truths will always remain for us to identify and respond to in our work with the human condition. This Code, it is hoped, will provide an ethical framework to guide us in this process" (Johnstone, 1999, p. 473).

Based on the need for formulate a "moral practice" in the nursing profession, Johnstone (1999) maintains that the need for informed and timely approaches to the delivery of nursing practitioner care can be improved by consulting the work of Sister Roach. According to Johnstone, "The agreed ethical standards of nursing require nurses to promote the genuine welfare and well-being of people in need of help through nursing care, and to do so in a manner that is safe, competent, therapeutically effective, culturally relevant, and just. These standards also recognize that in the ultimate analysis nurses can never escape the reality that they literally hold human well-being in their hands" (1999, p. 137). Therefore, nurse practitioners are tasked with performing in a fashion that is responsive and responsible and which are congruent with a virtue theory account of ethics (Johnstone, 1999). Moreover, Johnstone concludes that, "Also consistent with a virtue theory account of ethics is a nursing articulated 'ethic of care' regarded by many nurse theorists as the moral foundation, essence, ideal and imperative of nursing" (1999, p. 137).