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Conduct an analysis of the identified areas of elder abuse/carer neglect, legal implications and ethical principles from the Case:  Findings of the Inquest into the death of Marcia Clark.

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.

Overview of Elder Abuse and Carer Neglect

Elder abuse is an age-old phenomenon, although only talked about in recent past. Elder refers to any person above the age of 60. Studies say that the abuser is generally someone close to the victim like his own children, caregiver or someone at the old person’s home or nursing home. It can be a one-time incident or a continuous one. It comprises psychological, physical, financial or sexual abuse. It can be caused by neglect or by abandonment. It constitutes a gross violation of human rights. It is a significant public health issue, which needs special attention as statistics say that only 1 in 24 cases of such abuse comes in the light as old people are afraid to report instances of abuse to their families and sometimes against the families ("Elder abuse", 2018) .

It is a sad and derogatory instance when the caregiver, appointed nurse or sometimes even his own children abuses an elder. It is an established fact that most often the abuser is a person who has an authority over the abused, someone who is assigned with the responsibility of taking care of the elder. Emotional or psychological, physical, sexual or financial- there are many forms of abuse. While they mainly go through the abuse of neglect or abandonment (Baker PR, 2018). Neglect means the incapacity of the caregiver to provide necessary support to the elder who is in need of such care. It can intentional as well as unintentional with neglect based on providing the essentials like food, clothing, shelter, medicines and attention. The case of Marcia Clark is a stark example of neglect of the carer, her own daughter in this case.

Several factors lead to elder abuse. Abusers are mostly people who holds a place of trust to such elderly individual. They can be children, spouse or caregiver to the victims. Factors like unhealthy family situation can lead to domestic violence and family stress can lead to elder abuse. An abuser may have personal issues such as drug addiction or mental illness that might lead to carer neglect or elder abuse too. Cultural differences sometimes add to such social evil as well. Coroners can easily point out signs of physical and psychological abuses. Physical injury and pain is easily traceable through general check-ups and examinations. Marks from bruises, sores and broken bones take a long time to heal for old people. While psychological or mental abuse takes a deeper course. Mental stress, depression, fear, anger, anxiety are some of the signs medical practitioner look for in cases of elder abuse ("Australian Institute of Family Studies", 2018).

Key Presenting Concerns in Marcia Clark's Case

Nurses are one of the first persons to identify signs of elder abuse apart from the family members as many a time, the family members are the sole abusers.  Nurses can see the indications of mental or physical abuse as they spend a substantial amount of time with victims unlike the social community workers (Rosa & AGPCNP-BC, 2016). Therefore, it is extremely essential for nurses to be educated and vigilant about the various signs of abuse affecting the elders and well versed with the course of action. They should have the knowledge who to contact for help in such cases and how. Communication with the patient is essential. Even though they are given the benefit of doubt, the nurses should have a word with patients confirming their state of being. The registered nurses (RNs) are supposed to contact the Elder Abuse Helpline and give a sketch of the condition of the patient along with signs of abuse, physical or mental. Sometimes, nurses and caretakers abuse elders in the old age home or in the hospital as well (Griffith, 2018). The RNs should be aware of such situations and must act accordingly. Thus, they are responsible for detecting the various types of elder abuse and carer neglect at the earliest (Pillemer et al., 2016). They have a legal and professional duty to report the case and talk to the family of the elder. The emergency RNs must have the knowledge and skill to handle emergency cases involving physical, mental or sexual abuse. It is mandatory for nurses to provide the proper medical and nursing assistance to the victim along with informing the appropriate authority about any sign of abuse. (Cho, Cha & Yoo, 2015).

The Commonwealth, State and Territory and the local government address issues relating to elder abuse and carer neglect. Although there is no direct legislations, yet the Commonwealth have enactments pertaining to financial issues, provisions for retirement and care for the aged (Lachs & Pillemer, 2015). In Australia, social security law comprising of the Social Security Act 1999 takes care of the issues relating to abuses. The Guide to Social Security Law published by the Department of Social Services guides the decision-makers. The social security system strives to check abuses to older people caused by misuse of such person’s financial support. The security system bears the role of imparting information about an abused elder, identifying the ones at risk and eventually protecting them from further abuse (Roberto, 2016). In addition, Section 8(1) of The Coroners Act 2009 asks for immediate record in writing of the distinguished aspects of the death of a victim when an inquest is conducted.

Factors Contributing to Elder Abuse

Australia suffers majorly on the issue of elder abuse due to the lack of a proper law regarding the matter. The country took 15 years to come out with recommendations regarding elder abuse and carer neglect after WHO had laid down its guideline on the same ("Global status report on violence prevention 2014", 2018). There are still no specific provisions for offences targeting elder abuse under the Australian criminal law. However, there is a mention of special duty for people who are under the obligation to provide the essential and primary needs of life under Section 262 of the Western Australia Criminal Code. The Aged Care Act of 2007 does not define elder abuse as it only strives to compile guidelines for protecting the well-being of the elders. The country lacks enactments on elder abuse even though it has laws on adult protection. Nevertheless, these enactments state that the caregiver must do the needful to protect the elder from any sort of abuse or threat of abuse (Lacey, 2014).

The registered nurses (RNs) have certain legal obligations to report instances of elder abuse. It involve the queries as to whether to report the abuse, how to report such abuse and what are the measures to adopt to prevent further abuse. Although a RN is not bound by any law to report an abuse, yet the Professional Code of Ethics lays down a moral duty on the nurses to detect and report cases of elder abuse, as they are one of the first persons to recognize the problem ("World report on ageing and health 2015", 2018). The Australian Law Reform Commission has laid down several recommendation for a nurse’s duty to protect an elder from further abuse. A RN must have the knowledge about the authorities that work for preventing elder abuse, like community groups or governmental organizations. The RN should be vigilant to notice the signs of abuse like traces of dehydration, soreness, muscle loss, malnutrition, depression and other.  Although a RN has the right to report a suspicious case of elder abuse, yet he is not covered against defamatory charges if such report is eventually proved wrong (Mitchell, 2018).

Mrs. Marcia Helena Clark, an 83 years old woman was under the care of her daughter Nardia Clark when she was brought to the Manning Base Hospital in Taree on 17th of July 2014. She died on the 20th with the doctors pointing out the negligence cause by the caregiver. The autopsy report clearly says that Mrs. Clark died of severe infection and malnutrition. The coroner pointed out several reasons pertaining to the old woman’s death; one of which has to be the dirty, unhygienic and unkempt environment at her house that the paramedics found at her place while bringing her to the hospital. It was evident that she was dehydrated and malnourished with deformed legs and acute pain all over her body. Infection on the sacral area of her lower back, on the sacrum bone and early bronchopneumonia affected her significantly as well. The doctors detected that Mrs. Clark had a high chance of dying at the time of admission. It was clearly mentioned by the doctors that she was a victim of elder abuse and carer neglect, and they made no delay to contact the Elder Abuse Helpline.

Responsibilities of Registered Nurses

Marcia Clark’s daughter, Nardia Clark was in charge of taking care of her mother. It was speculated that Nardia was unable to care for herself, thus quite inadequate to take care of her mother, an ailing 83 years old bed ridding woman. The paramedics who took charge of Mrs. Clark noticed that Nardia was unkempt, dirty herself, and was extremely confused about her mother’s health. She had no proper knowledge about her mother’s medical history. It was known from one of her sisters that Nardia was infected with a virus, which might speak for her unkempt and messy state. It was seen by the hospital staff that Nardia lacked insight about Mrs. Clark’s condition. She was unable to explain as to why she failed to arrange for medical assistance for Mrs. Clark. Even after a year of Mrs. Clark’s death, Nardia was found to be in the same dirty and unkempt state and her living condition was still inadequate.

It was a gross negligence in terms of law and ethics on Nardia’s part as she failed miserably to take care of her ailing mother. While Dr. Doan, Marcia Clark’s long time supervising doctor acted according to the ethical principles of justice, non-maleficence and beneficence, but it was not enough at certain circumstances. ("Elder Abuse Forum: A Human Rights Perspective | Australian Human Rights Commission", 2018). Being a daughter and caregiver, it was Nardia’s sole responsibility to take care of her mother, to keep a regular tab on her health, to be well versed with her medical history, to look after her hygiene; yet, she did not do any of it. On the other hand, Dr. Doan had confessed that his reports on Marcia Clark’s medical case were inadequate as most of the time, Mrs. Clark was not present and Nardia would come alone for consultation. It was quite difficult on his part to assess a patient without her presence. His records of the case were insufficient to speculate the medical condition of Mrs. Clark. Even on days when Marcia Clark was present for the check-up, the doctor’s notes were still deficient. However, he helped Mrs. Clark by referring to ‘Helping Hands’ homecare service (Mariam et al., 2015). He offered to provide home visit facility to attend Mrs. Clark, which was truly an ethical and humanitarian approach on his apart. Dr. Doan mentioned that he did not see any sign of neglect from Nardia’s part towards her mother, yet it was proven that the doctor had only seen Mrs. Clark on certain occasions over a span for a few years; therefore, it is quite impossible for him to judge the level of care. Although he tried to help Marcia Clark to the best of his ability and judgment, but it was evident that such care was not sufficient.

Legal Implications in Australia

A registered nurse (RN) has the responsibility to take utmost care of the patients and provide with all the necessaries a patient needs. A RN is supposed to participate in promoting health and awareness relating to health, help in developing a healthier community by preventing illness and disseminating concepts of rehabilitation and palliation (Smolowitz et al., 2015). The RNs should be well observant of a patient’s condition and should be analytical of such condition, unlike the case of Marcia Clark where the attending doctor, Dr. Doan and the nurses failed to recognize carer neglect and abuse for year after year until she was brought to the Manning Base Hospital (Loh et al., 2015).

Conclusion

Therefore, it can be concluded that elder abuse and carer neglect is a social issue that is coming out in the light more and more with time and growing awareness. The carer must carry out his duties with fail as that would affect the patient’s condition which is sometimes fatal, like in Marcia Clark’s case. If the caregiver is unable to take care of the elder, he or she must approach various care home facilities or social community workers. While, when an elder is admitted to a hospital or facility centre, the registered nurses bear the responsibility to scrutinize the overall health condition of the elder and take action accordingly. If the RN sees that the elder is suffering from any form of abuse; like psychological, financial, physical or sexual, then the RN is under the ethical obligation to report such abuse to the Elder Abuse Helpline. The RN should arrange for the possible help to improve the situation of such abused victim. It is, however, truly shameful and saddening to witness an elder being abused and tortured at the fading end of his or her life.

References:

Australian Institute of Family Studies. (2018). Retrieved from https://aifs.gov.au/publications/elder-abuse/export

Baker PR, e. (2018). Interventions for preventing abuse in the elderly. - PubMed - NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27528431

Cho, O. H., Cha, K. S., & Yoo, Y. S. (2015). Awareness and attitudes towards violence and abuse among emergency nurses. Asian nursing research, 9(3), 213-218.

Elder Abuse Forum: A Human Rights Perspective | Australian Human Rights Commission. (2018). Retrieved from https://www.humanrights.gov.au/news/speeches/elder-abuse-forum-human-rights-perspective

Elder abuse. (2018). Retrieved from https://www.who.int/news-room/fact-sheets/detail/elder-abuse

Global status report on violence prevention 2014. (2018). Retrieved from https://www.who.int/violence_injury_prevention/violence/status_report/2014/en/

Griffith, R. (2018). Neglect by carers. British journal of community nursing, 23(8), 407-409.

Lacey, W. (2014). Neglectful to the Point of Cruelty; Elder Abuse and the Rights of Older Persons in Australia. Sydney L. Rev., 36, 99.

Lachs, M. S., & Pillemer, K. A. (2015). Elder abuse. New England Journal of Medicine, 373(20), 1947-1956.

Loh, D. A., Choo, W. Y., Hairi, N. N., Othman, S., Mohd Hairi, F., Mohd Mydin, F. H., ... & Ramli, R. (2015). A cluster randomized trial on improving nurses’ detection and management of elder abuse and neglect (I?NEED): study protocol. Journal of advanced nursing, 71(11), 2661-2672.

Mariam, L. M., McClure, R., Robinson, J. B., & Yang, J. A. (2015). Eliciting change in at-risk elders (ECARE): evaluation of an elder abuse intervention program. Journal of elder abuse & neglect, 27(1), 19-33.

Mitchell, B. (2018). IDENTIFYING INSTITUTIONAL ELDER ABUSE IN AUSTRALIA THROUGH CORONIAL AND OTHER DEATH REVIEW PROCESSES. MACQUARIE LAW JOURNAL, 18, 35-56.

Pillemer, K., Burnes, D., Riffin, C., & Lachs, M. S. (2016). Elder abuse: global situation, risk factors, and prevention strategies. The Gerontologist, 56(Suppl_2), S194-S205.

Roberto, K. A. (2016). The complexities of elder abuse. American Psychologist, 71(4), 302.

Rosa, W., & AGPCNP-BC, C. C. (Eds.). (2016). Nurses as Leaders: Evolutionary Visions of Leadership. Springer Publishing Company.

Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E. M., Ulrich, S., Hayes, C., & Wood, L. (2015). Role of the registered nurse in primary health care: meeting health care needs in the 21st century. Nursing Outlook, 63(2), 130-136.

World report on ageing and health 2015. (2018). Retrieved from https://www.who.int/ageing/events/world-report-2015-launch/en/

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