Sister Simone Roach's Six C's of Caring in Nursing

Introduction

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, 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 healthcare improvement, and how this nurse ethicist can inform nursing research for the nurse practitioner.

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 birth date is provided in her official biography, it 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, and completed graduate study at the 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, however, and Sister Roach went on to complete two 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 completed 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 at St. Francis Xavier University (Sister M. Roach biography, 2011).

Sister Roach was also a key figure in developing a code of ethics for the nursing profession. 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, remained an influential resource providing a useful framework for nurses in their ethical decision making until the 1970s (Johnstone, 1999). Over time, there were increasing calls for an ethical code specifically suited to the unique healthcare situation in Canada. These issues were addressed at the CNA's 1978 Annual Meeting, when the creation of a new national code was made a priority. In 1979, Sister Simone Roach was designated as project director for this initiative (Johnstone, 1999).

Contributions to Nursing Scholarship and Practice

According to McKenna (1997), during the 1990s a number of healthcare professionals began work to expand and build on the prior contributions of nurse theorists in an effort to keep nursing scholarship timely and relevant for the 21st century. These efforts were built on the foundation established by Sister Simone Roach's earlier theories of caring (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 a sixth addition: Compassion, Competence, Confidence, Conscience, Commitment, and Comportment.

The body of nursing scholarship is illuminated by Sister Roach's reflections on these components of caring throughout 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.
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 and family.
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 that "caring is the human mode of being." We care not because we are nurses, physicians, social workers, or parents, but 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 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" — an ever-expanding development driven by rapid advances in science and technology (Sister M. Roach biography, 2011).

Conclusion

Sister Marie Simone Roach was born in Cape Breton, Nova Scotia, Canada. Following her graduation from St. Joseph's School of Nursing, Glace Bay, Nova Scotia, she completed a year of nursing practice and then joined the Sisters of St. Martha, Antigonish, Nova Scotia, where she worked in a number of clinical areas and taught in various schools of nursing. Sister Roach is best known for her "Six C's" of nursing care — Compassion, Competence, Confidence, Conscience, Commitment, and Comportment — a framework that provides practical guidance for the delivery of nursing services. She was also shown to be a prolific author and active original researcher whose work has become fully integrated into the mainstream of nursing theory, and whose contributions to nursing ethics continue to inform the professional practice of nurse practitioners worldwide.

References

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