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Conduct an analysis of elder abuse and carer neglect identified in the Coroner case. This analysis should include definitions of elder abuse and carer neglect; the key presenting concerns that lead to the establishment of elder abuse and the key presenting factors that the Coroner identifies with potential carer neglect occurring prior to Marcia Clark’s admission to hospital.

Use relevant and recent literature to assist your critique that relates to elder abuse and patient care standards in Australia.
Validate your points with literature related to elder abuse and palliative care in the community.
Discuss the role of the registered nurse, knowledge, communication, monitoring,family meetings, reporting, accountability, delegation and responsibility.

Patient Safety

According to the World Health Organization (WHO) elder abuse and neglect refers to failure to take appropriate action to prevent the causation of harm to an elderly person or engaging in actions that cause harm or distress to an older person within the confines of trust between the elderly person and the caregiver (WHO, 2008). Further, the WHO perceive carer neglect as the failure by a caregiver to advance the necessary basic needs to an elderly person who is literally unable to take care of him/herself,

These definitions and observations by WHO emanate from the realization that older persons are vulnerable to harm, exploitation, abuse and neglect from caregivers and family members across the globe. This situation is especially the case where the older person is under medication and deserves to be taken care of. In this paper, a reflection through evaluation and analysis will be conducted with regard to the abuse and neglect of Marcia Clark by her daughter Nardia. In doing so, insights will be drawn from; “Findings of the Inquest into the Death of Marcia Clark” case filed and documented by Australian coroner; Teresa O'Sullivan.

Patient Safety

Indeed, going by the WHO definitions, the Marcia Clark’s health condition and the caregiving situation at her advanced age explicitly expound rampant elder abuse and caregiver neglect. The autopsy report by the forensic pathologist, Dr. Brian Bear vividly showcases that Mrs. Clark’s death was as a result of severe malnutrition and infection. This cause of death is evidence enough that Mrs. Clark was abused and neglected. Upon inquest into the case, Mrs. Clark’s condition was described as being extremely terrible by the Ambulance officers when they paid her a visit on 17 July 2014.

The house where she was kept was extremely dirty, unkempt and the paramedics were literally assaulted by the smell that came out of the room Mrs. Clark resided. Moreover, Mrs. Clark herself was emaciated, malnourished and dehydrated, and laid on a dirty bed extremely wet with excrement. Furthermore, pressure sores were observed all over Mrs. Clark's body. Such observations point out that Mrs. Clark had been kept in one position for a long period of time leading to the sacral bone infection. Nardia admitted to this upon being quested.

By Nardia agreeing to take care of her ailing mother, she literary consented to engage in a formidable trust relationship in care between herself and her mother. Mrs. Clark's bedsores and skin infections were noted as early as 2012. This means that Nardia had adequate time to take correction action. Although scanty medical records depict that she took some actions to salvage the situation such as seeking assistance from Meals on Wheels and Helping Hands groups, this was done rather very late. Moreover, though, Teresa O'Sullivan describe Nardia as a carer who might have been exhausted, stressed and struggled to take care of herself, this does not remove the fact that she still had the conscience of taking fast and appropriate corrective action to salvage the situation.

Legal Implications of Elder Abuse

            Most of Mrs. Clark’s medical history was scanty indicating the health practitioners’ failure to adequately document the same. Dr. Thai Doan who was extensively involved in the treatment of Mrs. Clark relied on oral evidence from Nardia about her mother's condition, believed and acted on the same in extending care. This was absolutely unprofessional. Indeed registered nurses have an obligation to acquaint themselves with the requisite medical history of a patient and documenting the same before extending any kind of care. They also have an obligatory role of examining a patient in person rather than relying on the observations of caregivers to be in a position to extend holistic care (Bedin, Droz?Mendelzweig, and Chappuis, 2013).    

This allows them to collect the necessary information to contribute to their knowledge about a patient's health care condition and by extension advancing the right kind of care. In line with advancing a patient-centered kind of care especially in a palliative setting, nurses ought to employ effective communication with the patient and the family members (Kurrle and Naughtin, 2008). This establishes a rapport that allows the patient and the family members to decide how best their patient is supposed to be treated. In doing so, nurses can call for a family meeting, adequately report and account of the patient’s progress.

Legal Implications of Elder Abuse

            Elder abuse legal implications are not only complex but also multifaceted and by and large call for the intervention and collaboration of professionals drawn from diverse disciplines (Donovan, and Regehr, 2010). Thy draw legal responses from Commonwealth, territory, state as well as local government jurisdictions. For instance, while the Commonwealth is involved with making laws that touch on financial institutions, aged care, and superannuation.

the state and territories make laws relating to decision-making such as the powers of the attorney, and guardianship.  Fundamentally, in practice, addressing wrongdoings concerning elder abuse call for the interpretation of different legal provisions within a complex policy, and justice system framework. However, by and large, protecting and safeguarding against elder abuse demands the address of an array of intervention points.

These include; risk- this relates to identifying the elder person at risk and determining how the risk can be avoided or minimized. Reporting- this relates to identifying the means of presenting that elder abuse has occurred as well as who needs to be reported to of the same. Response relates to advancing the means of investigating the alleged elder abuse indeed occurred while redress seeks to sort for legal remedies for abused elders. In community settings, registered nurses working with families need to carefully observe these procedures in order to determine that indeed an elder has been abused before taking intervention measures such as reporting the same.

Ethical Issues

The Australian Government Aged Care Amendment (Security and Protection) Act 2007 introduced the compulsory reporting of abuse amongst the elderly. To this end in a position statement, the  Australian Nursing and Midwifery Federation (2018) mandates all registered nurses to report suspected or actual incidences of elder abuse whenever they came across them. The nurses are obligated to report the same to their employers or directly to the police, the Aged Care Complaints Commissioner, the Department of Social Services or to various relevant jurisdictions.

The person reported to must take the appropriate legal action in investigating the matter and subsequently advice the registered nurse that action was taken and in what ways. If the nurse is not satisfied with the action taken, they are obligated to report to a higher authority. Nurses are not supposed to be victimized or discriminated upon in their workplaces as a consequence of making the report. While engaging in this legal tussle, registered nurses ought to observe relevant nursing codes of ethics and professional conduct (Cooper, Selwood and Livingston, 2009).

In judging whether to lodge a complaint and subsequently making a report concerning elder abuse, registered nurses need to have observed peculiar elements to justify their complaint. Primary symptoms and signs indicating elder abuse and neglect as in the case of Mrs. Clark include dehydration, poor hygiene, bedsores, emaciation, and malnutrition. Abused and neglected elder persons    present issues of having long time unattended healthcare concerns. Moreover, nurses need to look out the general environmental condition that the elder person lives (McCabe, Alvarez, McNulty, and Fitzpatrick, 2011). Furthermore, other telling elements nurses can rely on relating to behavioral signs such as loneliness, isolation, anger, depression, confusion, non-responsiveness and constantly giving contradictory statements.     

Drawing from the Coroner Case, Mrs. Marcia Clark showcased a multiplicity of signs and symptoms that vividly indicated abuse and neglect. Reporting nurses can substantiate their claim by pointing out factors such as being left in blatant unhygienic conditions besides having abnormal behaviors including isolation and depression. Other factors relate to having uncaring caregiver evidenced by Nardia's poor history of her mother's predicaments, medical neglect evidenced by not having adequate medical records, self-neglect evidenced by Mrs. Clack's refusal to see outsiders and psychosocial abuse evidenced by being confined in a poorly lit and dirty room (Gibbs, 2014).

Ethical Issues

            Nardia’s neglect of her carer duties to her mother breached all ethical virtues one can ever think of. She was supposed to act in the best interest of her mother by showcasing her tender love by attending to her most basic livelihood activities. Mrs. Clark was clearly not in a position to make important decisions about her condition and therefore Nardia’s decisions would have been enough to suffice her situation. Neglecting Mrs. Clark in the conditions she was found in on 17 July by paramedics brought out Nardia as a person with little or no ethical virtues such as being loving, caring, compassionate, sympathetic, kindhearted or empathetic. These ethical virtues define who a true and committed carer is (Bergeron and Gray, 2003). Though she showcased some form of care by seeking help from different elder support organizations, this was not enough to warrant any appreciation.

Indeed, Nardia contributed further to Mrs. Clark’s predicament by failing to paint the right picture of her mother when she paid visits to the General Practitioner Dr. Doan. Dr. Doan contends that according to Nardia’s description of her mother’s situation, he deduced a loving and respectful relationship between mother and daughter. Dr. Doan, therefore, failed to establish that actually Mrs. Clark was being neglected by her daughter Nardia.   Moreover, like her mother desired, Nardia further contributed to her mother’s predicament by locking their home from the outside world.

These actions were not only unfair but also by and large unethical. Her actions were mare acts of injustice to Mrs. Clark as her principal carer. Justice  in ethical concerns such as this is the upholding of what is right and in this case, what was right was extending care amicably (Gorbien and Eisenstein, 2005). By only relying on Nardia’s report, Dr. Doan failed to act in the best interest of her patient compromising on the principle of beneficence in healthcare. He ought to have weighed the benefits and burdens of his clinical options to advance Mrs. Clark the best care she deserved. 

This notwithstanding, Mrs. Clark was not in a position to make entirely autonomous decisions since her healthcare condition had by and large compromised on her independent decision-making capacity. She could not self-determine what is right or wrong for her no wonder she was found in the condition she was in by paramedics. Indeed, Nardia intended to harm and eventual death of her mother irrespective of her depressed and virus infestation condition.  Nonmalfeasance principle demands caregivers to desist from negligence from their duty and by extension preventing harm to those that they care for (Dong, 2015). Though confidentiality is a critical ethical concern in healthcare, Nardia’s action of not disclosing enough details to Dr. Doan compromised the whole situation further subjecting Mrs. Clark into jeopardy. Restricting people from accessing their home only compounded their problems.

Registered nurses in general practice and who care for families that in turn care for loved ones at home play a critical role in managing the patient’s progress. It remains incumbent upon them to advance a patient-centered care even when the patient is in the direct care of loved ones. Dr. Doan failed to extend such care and only relied on incorrect reports from Nardia. Registered nurses have a professional duty to institute intimate relations with the patient and the family besides deducing and implementing the most rewarding nursing care. They are supposed to remain communicative; able to advance effective monitoring of the situation through family meetings and efficient reporting; delegate responsibilities where applicable besides being accountable for all their responsibilities.

The effective execution of these roles and responsibilities not only advance a patient-centered care but also allow registered nurses to remain ethical in the course of their duty. Yaffe, Wolfson, and Lithwick, (2009) insist that in the course of their duty, nurses are in a position to maintain a safe level of nursing practice besides advancing patients their autonomy, justice and the right to self-determine the kind of care they would wish for. Such a nursing footing gives a nurse a leeway in case of blame apportionment in future when things go wrong as well as being in a position to act in the best interest of the patient (Shinan-Altman, and Cohen, 2009).


According to Kaspiew, Carson, and Rhoades, (2016) elder abuse need to be shunned and condemned when we come across it. Elder abuse and neglect constitute the worst human abuses an elderly person can be subjected to and especially for those under medication. Regardless of her stressful and sickly condition, if Nardia took adequate necessary actions to salvage Mrs. Clack’s situation early enough, then Mrs. Clack would have lived a little longer. Indeed, the case; Findings of the Inquest into the Death of Marcia Clark opens to us the realities of elder abuse and neglect besides showcasing how both legal and ethical concerns can complicate the delivery of justice on the same.


Australian Nursing & Midwifery Federation (2018). Compulsory reporting of abuse in aged care

settings for nurses and assistants in nursing [Retrieved from]

Australian Government (2018). Aged Care Amendment (Security and Protection) Act 2007

Bergeron, L. R., & Gray, B. (2003). Ethical dilemmas of reporting suspected elder abuse. Social

Work, 48(1), 96-105

Coroners Court Of New South Wales (2018). Inquest into the death of Marcia Clark.

Cooper, C., Selwood, A., & Livingston, G. (2009). Knowledge, detection, and reporting of abuse

by health and social care professionals: a systematic review. The American Journal of Geriatric Psychiatry, 17(10), 826-838.

Dong, X. Q. (2015). Elder abuse: systematic review and implications for practice. Journal of the

American Geriatrics Society, 63(6), 1214-1238.

Donovan, K., & Regehr, C. (2010). Elder abuse: Clinical, ethical, and legal considerations in

social work practice. Clinical Social Work Journal, 38(2), 174-182.

Gorbien, M. J., & Eisenstein, A. R. (2005). Elder abuse and neglect: an overview. Clinics in

geriatric medicine, 21(2), 279-292.

Gibbs, L. (2014). Medical Implications of Elder Abuse and Neglect, An Issue of Clinics in

Geriatric Medicine, E-Book (Vol. 30, No. 4). Elsevier Health Sciences.

Kaspiew, R., Carson, R., & Rhoades, H. (2016). Elder abuse: Understanding issues, frameworks, 

and responses. Australian Institute of Family Studies.

Kurrle, S., & Naughtin, G. (2008). An overview of elder abuse and neglect in Australia. Journal

of elder abuse & neglect, 20(2), 108-125.

McCabe, D. E., Alvarez, C. D., McNulty, S. R., & Fitzpatrick, J. J. (2011). Perceptions of

physical restraints use in the elderly among registered nurses and nurse assistants in a single acute care hospital. Geriatric Nursing, 32(1), 39-45.

Shinan-Altman, S., & Cohen, M. (2009). Nursing aides' attitudes to elder abuse in nursing

homes: The effect of work stressors and burnout. The Gerontologist, 49(5), 674-684.

World Health Organization.  (2008).A global response to elder abuse and neglect: Building

primary health care capacity to deal with the problem worldwide. Geneva: WHO.

Yaffe, M. J., Wolfson, C., & Lithwick, M. (2009). Professions show different inquiry strategies  

for elder abuse detection: Implications for training and interprofessional care. Journal of interprofessional care, 23(6), 646-654.

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