User talk:Tbolden

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Hello Tbolden, and Welcome to Wikipedia!

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Happy editing! Moonriddengirl (talk) 17:05, 30 January 2009 (UTC)[reply]

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Rescue barnstar[edit]

The Article Rescue Barnstar
For your timely and excellent assistance with Hospice care in the United States Moonriddengirl (talk) 15:21, 1 February 2009 (UTC)[reply]


This is a Wikipedia award (see Wikipedia:Barnstars if you want to know more about them). It has no substantial value (you can't trade it in for a cup of coffee), but it's one way that editors can acknowledge a job well done, so some of us like them. :) Job well done! We are very lucky that you happened into the conversation when you did and contributed to the article, as we have wound up with one fine article. I have moved your version into article space and am doing some of the formatting and citations that Wikipedia requires (picking up again after this brief break.) Thank you very much for your intervention here, and I hope that now that you've had a taste of it, you'll keep contributing to Wikipedia. We can certainly use the assistance. :) --Moonriddengirl (talk) 15:21, 1 February 2009 (UTC)[reply]
Helping out with sourcing was my pleasure. Quite often, as an administrator addressing copyright concerns, I wind up having to rewrite articles myself, and I had very little familiarity with the subject. I'm grateful to you for giving us your time and knowledge, without which our coverage of this topic would likely have been far less complete. --Moonriddengirl (talk) 21:05, 1 February 2009 (UTC)[reply]

←Just in case you're curious, the reason why I requested an assessment of this article is because I think it's probably one of the best "first efforts" I've ever seen. Assessments grade quality and reliability as well as offering suggestions for improvement. The various wikiprojects are entitled to give up to a "B" class. I think there's a pretty good chance this article could be brought up to "good article" status, which is as far in the process as I have personally ever gone. The highest "grade" of article on Wikipedia is the featured article. Of the nearly three million articles we have, there are currently only about 2,406 featured articles. These are the articles that are typically featured on the front page, and the evaluation process for them seems rigorous. If this article meets B class, I may well put it up for GA evaluation. I don't plan to drop it in the FA pool, as I lack the background that may be necessary to provide whatever further information they might request. If I can't find it in google books, I wouldn't know the answer. :D --Moonriddengirl (talk) 13:18, 2 February 2009 (UTC)[reply]

Hello, Tbolden. You have new messages at Moonriddengirl's talk page.
You can remove this notice at any time by removing the {{Talkback}} or {{Tb}} template.

Moving forward[edit]

The article has "B" status now, and the reviewer has left some suggestions...including that we pursue "Good Article" status. Do you want to give it a go? He's requesting some additional information. I can help add some of this, but if you can add more information on how respite care works especially, that would be very helpful. :) You can find his comments at Talk:Hospice_care_in_the_United_States#update. --Moonriddengirl (talk) 11:52, 6 February 2009 (UTC)[reply]

Hi. :) I note that you sort of went back and forth on my talk page yesterday, and even though you wound up deleting your note just wanted to address it anyway. Point 1: You make your changes directly to the article. We encourage contributors to be bold. The reason it was different before was because the article was a copyright violation, so we had to suppress publication. Now that the copyright infringing version is gone, it's business as usual. That said, if you want to work on it together, we can do that in user space. Let me know, and I'll be happy to collaborate with you on it. Point 2: A section where patients and families can ask questions about hospice care sounds like a great idea for a website, but probably not for Wikipedia. What we're aiming for here is the same kind of presentation you might find in, say, Encyclopedia Britannica. We're not so much interactive as a straightforward, informational resource. A Q&A sections sound more like a guide feature than an encyclopedia feature. Now, if you can find a good, neutral website that includes such a feature or that gives great resources to families and patients, it would be very appropriate to include a link to it in our "external links" section. I think what the article probably most needs now is:
  • Information about who doesn't qualify for hospice care. The reviewer asked, "Don't federal hospice guidelines require the patient to stop cure-oriented treatment? I was under the impression that this was a major problem with extending hospice care to children (whose parents naturally are unwilling to stop treatment when there's a small chance that the next thing might work)." Do you know the answer to this? If not, we can probably unearth it through research.
  • Additional information about the patient demographics. Are hospice services available for/utilized by children and younger adults? I can probably find more about that one, if you don't know.
  • Additional detail about respite care. The reviewer wanted to know, "Can respite care be round-the-clock care? Does this let family members leave town for up to 5 solid days during a cycle? I'm having trouble understanding how this is different from regular care." Since the reviewer seems familiar with hospice, if he has questions, others are likely to have questions as well. :) I don't know the answers to these, either. --Moonriddengirl (talk) 14:14, 10 February 2009 (UTC)[reply]
LOL! I struggled with whether to respond anyway, but I didn't know if you pulled the question because you didn't want to bother me or because you figure it out yourself. In case it was the first, I decided to answer anyway. :D (If it was the first, please, feel free.) I'm in the process right now of adding information to the history section on the first dedicated pediatric hospice in the US. --Moonriddengirl (talk) 14:33, 10 February 2009 (UTC)[reply]
I'll take a look within the next couple of hours and see what I may be able to contribute. :) That will give you a chance to get it to your satisfaction (and give me a chance to do laundry. :/) --Moonriddengirl (talk) 21:55, 10 February 2009 (UTC)[reply]

←Those next couple of hours stretched on a bit, but I've had a look. :) I abbreviated it a bit both because it was a little informal and because I couldn't find reliable sources for some of it, such as the shift from "no radiation" to "okay, radiation." If we go for good article status, they are going to demand rigorous sourcing--material that doesn't link to something previously published, will be challenged and removed. I also moved it to philosophy because it seemed to me to fit better there.

At this point, I'm planning to see if I can add information on pediatric hospice and perhaps some general demographic info. Can you provide more information on respite care or suggest a book where I might find that? That would be very helpful. :) --Moonriddengirl (talk) 13:41, 11 February 2009 (UTC)[reply]

I'm retitled the "qualifications" section and am adding demographics there. If you disagree with that handling, let me know, and we can try to adjust accordingly. (Re: your cousin's advice, please do not get possessive of the article, as it will break your heart. One of Wikipedia's strengths is that anyone can contribute to almost any article. One of Wikipedia's weaknesses is that anyone can contribute to almost any article. :) It's the nature of the beast.) One thing we want to be careful about is overloading this particular article--it is already starting to get long, and that can be a problem in itself when it comes to evaluation. We should try to stay concise.
I'll get back with you on the respite care in a minute. I'm about to wrap what I'm doing and will turn it over to you. --Moonriddengirl (talk) 14:54, 11 February 2009 (UTC)[reply]
With respect to the respite stuff, never mind; looks like you covered it. I missed it while looking at your more recent additions. I've attempted to add some information on the pediatric population. Fortunately, Ferrell and Coyle had a good bit to say. Unfortunately, there doesn't seem to be any reliable information out there on the current demographics of patients overall--the latest information I found on pediatric hospice patients in the US is too old to be useful. But it may be enough. Do you think the article is in good enough shape now to request GA evaluation, or is there more information that you believe should be added? If you're ready for GA, I can list it. --Moonriddengirl (talk) 15:31, 11 February 2009 (UTC)[reply]

←Woohoo! A Wikipedia convert. :D I'll take a look today at the citation styles I've used to make sure they're all standard (sigh), and once I'm sure they are I'll put it up for GA. Watch the talkpage for further developments, as we'll soon find out what changes/improvements are recommended. I've never seen a GA evaluation where they didn't recommend anything, so I imagine there's work ahead. --Moonriddengirl (talk) 16:06, 11 February 2009 (UTC)[reply]

  • update It's been nominated for GA. It could be weeks, days, hours. At some point, somebody will show up to demand we make it better. :) --Moonriddengirl (talk) 23:05, 11 February 2009 (UTC)[reply]
Hi. :) I see that you're adding information to the article. You might want to be careful to source as you go, because unreferenced information is likely to cause the GA nomination to fail. If you can let me know what sources you're using, I'll be happy to help you figure out how to format it by wikistandards. --Moonriddengirl (talk) 19:02, 15 February 2009 (UTC)[reply]
As far as yanking information, not necessarily, but we do want to be sure that new additions are rigorously sourced. We also want to be careful not to alter too much, because "page stability" is a consideration in the GA process. If an article still seems to be under development, it won't pass. :) Let me look at those sources and see what can be done with them. --Moonriddengirl (talk) 19:56, 15 February 2009 (UTC)[reply]
Oh, by the way, I didn't notice that you'd left me a note about this before I contacted you! Unfortunately, my talk page can get busy, and when I get the "new messages" bar, I don't always think to check to see how many new messages I might have had. I missed yours because of newer material placed at the bottom. Sorry. :) --Moonriddengirl (talk) 19:57, 15 February 2009 (UTC)[reply]

We need a new section; that one is too long[edit]

Okay. Those look like excellent sources. :) The first source is the Cleveland Clinic Journal of Medicine June 2006 vol. 73 no. 6 517

The "wiki way" to cite this is using a "citation template." We use different ones for books, journals, newspaper, websites, etc. This one we'd want Template:Cite journal.

That would look like this: Blah blahdy blah blah blah blah blah.<ref name=Russell>{{cite journal |last= Russell |first= K. Mitchell |authorlink= |coauthors= Susan B. LeGrand |year= 2006 |month= June |title=I'm not that sick! Overcoming the barriers to hospice discussions |journal=Cleveland Clinic Journal of Medicine |volume=73 |issue=6 |pages=520 |id= |url=http://www.ccjm.org/content/73/6/517.full.pdf+html |accessdate=2009-02-15}}</ref>

In the article body, this shows up as a reference number. In the reflist, it looks like this:

  • Russell, K. Mitchell (2006). "I'm not that sick! Overcoming the barriers to hospice discussions". Cleveland Clinic Journal of Medicine. 73 (6): 520. Retrieved 2009-02-15. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)

Subsequent references to the same source would read <ref>Russell and LeGrand, 521.</ref>/nowiki> if its a different page. If it's the ''same'' page, it would read <nowiki><ref name=Russell/>. (When we get a reference a name, every time we tell it "ref name", we're telling it "repeat that reference." We have to include the back slash, though, to close the reference, or it will mess up formatting.

I'll continue immediately with source #2. --Moonriddengirl (talk) 20:08, 15 February 2009 (UTC)[reply]

I'm working on 2, but I realized I might not have explained something well. We don't have to anything to make it show up like that. Wikipedia will read the material between <ref></ref> or <ref name=whatever></ref> and automatically place it in the list. We just have to put it in the article body next to the material we've cited. --Moonriddengirl (talk) 20:19, 15 February 2009 (UTC)[reply]


Source #2 is going to be complicated. :/ I'm going with "citejournal" for it, since it seems Hastings Center Report is a journal, but this is a supplement, so somebody might tell us we should use a different citation style. I would do it this way:{{cite journal |last= |first= |coauthors= |year=2003 |month=March-April |title= |journal=A Special Supplement to the ''Hastings Center Report'' |page= |pages= |publisher=The Hastings Center |url= http://www.mywhatever.com/cifwriter/content/46/files/access_and_values_report.pdf| |accessdate=2009-02-15 }}

That would be my base. You'd have to personalize it depending on which articles you use. You mention page 27. That's part of the main text, not a sub-article. <ref name=Jennings>{{cite journal |last=Jennings |first=Bruce | coauthors=True Ryndes, Carol D'Onofrio, Mary Ann Bailey |year=2003 |month=March-April |title= Access to Hospice Care: Expanding Boundaries, Overcoming Barriers |journal=A Special Supplement to the Hastings Center Report |page=27 |publisher=The Hastings Center | url= http://www.mywhatever.com/cifwriter/content/46/files/access_and_values_report.pdf| |accessdate=2009-02-15 }}<ref/>

That will expand in the references list looking like this:

Anything that you can't source, you should remove. Unsourced information is a big no-no on Wikipedia. :) You see it in some articles, but those articles generally aren't going to be those that are good enough to pass a GA review.

Let me know if you need help with any of this sourcing. --Moonriddengirl (talk) 20:29, 15 February 2009 (UTC)[reply]

All right. I'm online and active, so I should be quick to reply. Let me know when you're ready. :) --Moonriddengirl (talk) 12:40, 16 February 2009 (UTC)[reply]
Sourcing is a pain, yes. :) It is fairly typical for there to be a lag in the GA review. It could be any minute, or it could take a couple of weeks. It depends on a volunteer from that project stopping by and deciding to put in the time evaluating it. --Moonriddengirl (talk) 20:06, 16 February 2009 (UTC)[reply]

←I anxiously wait it, too! We have become the oldest request on the page. I'm guessing the article is daunting to outsiders. :) --Moonriddengirl (talk) 13:14, 16 March 2009 (UTC)[reply]

We're on[edit]

But I'm off, because I'm exhausted. :) There are some specific improvements requested. If you haven't already communicated with me about it by the time I get back on Wikipedia tomorrow, I'll try to make some specific notes about what we should do at this point. (Of course, you can read the full note at the talk page of the article.) --Moonriddengirl (talk) 02:48, 21 March 2009 (UTC)[reply]

Next steps[edit]

Okay. I'm reviewing the recommendations, and I thought we could discuss here perhaps how to proceed.

  • I'll address alterations to the lead and history section. If I come up with something I can't answer, I'll talk to you about it. :)
  • Can you take a photograph of the hospice facility where you work? This isn't essential, but an image would be nice. :) We can only use images that are appropriately licensed by the photographer on Wikipedia, and I am coming up with nothing on US hospices, although I've found a few from around the world.
  • Can you clarify the following? If we discuss them here, we can come up with good sourcing & language before implementing in the article.
point 1
  • Philosophy para 1 states "Hospices typically do not perform treatments that are meant to diagnose or cure an illness.[10] In keeping with this philosophy, many hospice patients, though not all,[11] have made decisions not to receive CPR should their heart or breathing stop." This is a tricky area. I have three concerns with these sentences.
  • Although hospices do not perform curative treatments, I have difficulty with the notion that a patient's choice not to receive CPR is in any way connected with this. Is it the case that there are hopsices that would not provide CPR if a patient wished to receive it in the event of heart failure? While I imagine some may not be equiped for this, that does not seem to be related to their philosophy or function. "In keeping with this..." seems the wrong way to approach this subject.
  • Second, I would not suggest that the fact that hopsices to do not do diagnosis etc is a matter of "philosophy". It seems the wrong word. It may be a matter of policy, or a feature of the functional divisions in the health care system.
  • Third, "Hospice does not seek to hasten death or extend life" is probably the general philosophy of some in the sector, but I would suggest not all. There may be a point-of-view (POV) issue here. I would suggest that some hospices would regard "extending life" (possibly expressed as "extending the quality of life", but probably including extending life in practical terms) as part of their objective. You might want to look carefully at the objectives or operational parameters of any hospices administered within the Catholic Church's care arm, for example (I am assuming there are such entities in the US as there are here). I am not an expert, though, and am happy to hear further discussion of this. I would certainly suggest that the sentence "Hospice does not seek to hasten death or extend life" needs its own citation.

I'll see what I can do about addressing the other issues. :) --Moonriddengirl (talk) 14:12, 21 March 2009 (UTC)[reply]

sorry, I re-read your suggestion--Should I be responding to your talk page, let me know. This is a link to pictures of our hospice http://cchnet.net/hospice_facility_tour1.htm But, just to clarify hospice is not necessarily a place but a philospphy towards care so a picture can be hard to find. However, we have inpatient hospice facilities and these are there pictures. I could provide explanation of the rooms if that would be helpful in the images. Tbolden (talk) 1

Regarding CPR, ok, in the past hospice's could refuse to accept patients who were full codes (wanted CPR), a federal law was passed (i will try to find references) stating that a hospice could not refuse admission of a patient simply because of there code status. However, many hospices (though I imagine not all)will have in there informed consents that hospice staff do not perform CPR for patients--hospice nurses can essentially be conscientious objectors to CPR. So...should a patient's heart/breathing stop and they receive CPR this would be an implied revocation and the patient would be discharged from hospice. At the hospice's that I have worked at, should a patient be at home and "code" our nurse would call 911 but not necessarily perform CPR. In inpatient hospice units the nursing staff would not automatically "code" the patient but rather would transfer the patient to the emergency room. I don't know if my explanation is going to be user friendly but that is the essential phiolosphyTbolden (talk) 16:45, 21 March 2009 (UTC)[reply]

Ok, regarding point 2, while I am not totally sure of the difference in wording with respect to diagnosing illnesses, I think I see where he is going and basically agree. Perhaps this would work "In keeping with the philosophy of hospice, most hospice providers as a matter of policy do not perform diagnostic tests. Patients who request intensive testing of a hospice related diagnosis would usually be discharged from hospice and can be re-admitted at a later date when diagnostics are completed." BTW, I did add hospice related diagnosis because a patient may receive diagnostics to there hearts content (pun intended) for a problem which is unrelated to hospice.Tbolden (talk) 16:52, 21 March 2009 (UTC)[reply]

Regarding hastening of death, I can site other hospice web sites which state there goal is not to hasten death. So I would say the goal of hospice is definitely not to hasten death and to state otherwise would be a POV debate probably best left elsewhere. Should I cite the source regarding hastening of death?Tbolden (talk) 16:56, 21 March 2009 (UTC)[reply]

I new you would be impressed with my POV comment! I have you to thank. I am going to skip point 2, regarding certification of hospices. I can not imagine there are hospice's which are unlicensed and have no intention of getting licensed. To do so would mean they would have no payor source for any of there services. Medicare would not pay and most insurances will not pay a hospice unlicensed by Medicare. What I could add however; licensed hospices must meet certain Conditions of Participation(COP's) which state how the hospice should operate and what type of care and services they must provide. And on a side note, I know the reviewer was confused about the "hospice largely defined by Medicare..." and I would add that this is why it is not just funded but defined by Medicare, in the COP's Medicare tells the hospice how they should operate. I will work on this part. Tbolden (talk) 17:18, 21 March 2009 (UTC)[reply]

Okay on the various. You try to find sourcing. I'll try to find sourcing. :) At this point, we don't want to change the article unless it is with sourced information, so let's see what we come up with before clarifying that. (POV debate! Look how far you've come in Wiki-talk! You'll be hardcore in no time!) (I think I can help with the not hastening death thing; I'll get on it.) --Moonriddengirl (talk) 17:07, 21 March 2009 (UTC)[reply]

Either way is fine. When you respond on my page, it does have the advantage of letting me know. :) I'll see it on your page, too, but not as quickly as I'm in the middle of working on the article. So maybe the back and forth works best for us. Let me go take a look at your pictures. --Moonriddengirl (talk) 16:38, 21 March 2009 (UTC)[reply]

If you're in position to license some of those pictures so that Wikipedia can use them, they would work fine. We don't need a lot; we could run one of them next to the "in-patient" care section, with a description "An in-patient room blahblah". Here's the tricky part: since they're already published on the internet, you'd have to jump through a hoop or two to prove that Wikipedia has permission to use them. Wikipedia is pretty cautious about copyright infringement, to the point that it requires external verification just to be on the safe side. The easiest thing to do is to pick the picture you want to use and put a licensing statement on the website allowing that picture to be reused. Slightly harder, you pick the picture you want and then send a letter to the Wikimedia Foundation allowing it to be used. I can help you with the language for either of those options. This is not essential for the GA review, so we can leave this to worry about later if you'd like. But if it's not hard for you to license one of those images on th website, I think it would be a good thing for the article. --Moonriddengirl (talk) 16:44, 21 March 2009 (UTC)[reply]
Tony. Give me a call and I'll walk you through the licensing steps. That way we can discuss if it you or Judy or Milt who has to license the images. The reason Moodriddengirl isn't just cross linking into articles is
  1. It is questionable from a copyright standpoint
  2. Wikipedia only uses images which are hosted on wiki for GFDL reasons.
jbolden1517Talk 18:54, 21 March 2009 (UTC)[reply]

←Hi, jbolden. Thanks for your help. :) I wanted to note that I've removed "point 2" related to providers above, as I've addressed some of that in the article itself and at the GA talk. --Moonriddengirl (talk) 19:07, 21 March 2009 (UTC)[reply]

I've removed the blue box for the same reason, although it's been addressed at GA talk. (Levels of care; yes, some don't provide all levels of care. Can't prove it yet.) --Moonriddengirl (talk) 19:24, 21 March 2009 (UTC)[reply]

Subsection[edit]

I think we'd usually have seven days. I believe I've addressed most of the points raised in a satisfactory manner, except for that big box still left up there, but our reviewer should let me know. :) It would be great if you could get images, because I think given images we might stand a shot at "Feature article." I'm out of time right now, but I'll try to follow up some of the information you placed above about that box. --Moonriddengirl (talk) 20:11, 21 March 2009 (UTC)[reply]

No worries. :) Everything I've done has been detailed on the GA talk page--actually, recorded as I did it. :) It's all under "specific points". If you read my notes there, you should be able to follow exactly what I did, and if there's a better way to handle something, we can certainly work it out. The question above is still hanging, though. I'm happy to try to start researching sources for your notes later, but I'm afraid that family duties are preventing my doing anything right now. :/ --Moonriddengirl (talk) 22:06, 21 March 2009 (UTC)[reply]
Oh, by the way, there are some questions there, too. If you have answers for any of them, feel free. For example, I found a figure for "out of pocket" expenses for home-based hospice, but I couldn't find anything on inpatient expenses. --Moonriddengirl (talk) 22:16, 21 March 2009 (UTC)[reply]

←Just wanted to let you know that I've already added sources for stigma and was working on sourcing the reimbursement as you made your note at the GA talk page. I haven't found anything yet. :) If you aren't familiar with them, I find google book search and google news search tremendously valuable. It's where I've found every source I've added to the article. :) It's a good place to do research quickly, although there are barriers to reading sources, particularly "pay" sources on google news. :/ Anyway, I hope that you're not feeling overrun by my efforts at the article; I tend to research quickly. My goal is to get it into GA as quickly as possible. We can look at possibly trying for "featured article" status afterward if you like. --Moonriddengirl (talk) 13:07, 22 March 2009 (UTC)[reply]

I've found some sources for the financial reimbursement issues, which I've added to the article. By the way, if your cousin hasn't explained, please remember that achieving GA status doesn't mean the article is locked from further improvement. :) If you find other or better sources, these can certainly be added and should be. You won't have wasted your time, since multiple sources are particularly useful for contentious information. --Moonriddengirl (talk) 15:53, 22 March 2009 (UTC)[reply]

The big philosophical question[edit]

I am making your userpage very messy. After all of this, we're going to have to cover how to archive. :)

Okay:

What the article says right now

The goal of all hospice agencies in the United States is to provide comfort to the patient.[1] How comfort is defined is up to the patient or, if the patient is incapacitated, the patient's family. This can mean freedom from physical, emotional, spiritual and/or social pain. Hospices typically do not perform treatments that are meant to diagnose or cure an illness.[2] In keeping with this philosophy, many hospice patients, though not all,[3] have made decisions not to receive CPR should their heart or breathing stop. Hospice does not seek to hasten death or extend life.[4] The decision not to extend life as well as the pulling back of diagnostic or curative treatments is often the greatest barrier for patients in accepting hospice care; it can also create conflicts in medical professionals attempting to provide it.[5]

Some confusion exists as to what treatments a patient may receive and still qualify for hospice care. Hospices may provide treatments that have been traditionally regarded as curative, including radiation therapy or antibiotics, if these are administered to improve quality of life.[6] Determination of appropriate treatment is made on a case-by-case basis.

Another aspect of the hospice philosophy is the patient-centered care they provide. As the focus throughout the United States has shifted from provider-centered care, many healthcare agencies market themselves as patient-centered; for hospice, this patient-directed care is integral and interwoven throughout the care which is provided,[7] and Medicare regulations reflect this philosophy.

References

  1. ^ Aiken, Lewis R. Dying, Death, and Bereavement. Allyn and Bacon. p. 214. ISBN 0205082513.
  2. ^ Old and Swagerty, 8.
  3. ^ Kinzbrunner, Barry M. (2002). 20 Common Problems in End-of-life Care. McGraw-Hill Professional. p. 308. ISBN 0070348839. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  4. ^ Plocher and Metzger, 122.
  5. ^ Sugarman, Jeremy (2000). 20 Common Problems Ethics in Primary Care. McGraw-Hill Professional. p. 122. ISBN 007063369X. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  6. ^ Birmingham, Jacqueline Joseph (2005). End-of-life Care: Case Studies and Cost Efficiencies to Help Case Managers Determine Appropriate Levels of Care. HC Pro, Inc. p. 102. ISBN 1578395526. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  7. ^ Kilpatrick, Anne Osborne (1999). Handbook of Health Administration and Policy. CRC Press. p. 376. ISBN 0824702212. {{cite book}}: Unknown parameter |coauthor= ignored (|author= suggested) (help).
What our reviewer said about it
  • Philosophy para 1 states "Hospices typically do not perform treatments that are meant to diagnose or cure an illness.[10] In keeping with this philosophy, many hospice patients, though not all,[11] have made decisions not to receive CPR should their heart or breathing stop." This is a tricky area. I have three concerns with these sentences.
  • Although hospices do not perform curative treatments, I have difficulty with the notion that a patient's choice not to receive CPR is in any way connected with this. Is it the case that there are hopsices that would not provide CPR if a patient wished to receive it in the event of heart failure? While I imagine some may not be equiped for this, that does not seem to be related to their philosophy or function. "In keeping with this..." seems the wrong way to approach this subject.
  • Second, I would not suggest that the fact that hopsices to do not do diagnosis etc is a matter of "philosophy". It seems the wrong word. It may be a matter of policy, or a feature of the functional divisions in the health care system.
  • Third, "Hospice does not seek to hasten death or extend life" is probably the general philosophy of some in the sector, but I would suggest not all. There may be a point-of-view (POV) issue here. I would suggest that some hospices would regard "extending life" (possibly expressed as "extending the quality of life", but probably including extending life in practical terms) as part of their objective. You might want to look carefully at the objectives or operational parameters of any hospices administered within the Catholic Church's care arm, for example (I am assuming there are such entities in the US as there are here). I am not an expert, though, and am happy to hear further discussion of this. I would certainly suggest that the sentence "Hospice does not seek to hasten death or extend life" needs its own citation.
What you said about his comments

Regarding CPR, ok, in the past hospice's could refuse to accept patients who were full codes (wanted CPR), a federal law was passed (i will try to find references) stating that a hospice could not refuse admission of a patient simply because of there code status. However, many hospices (though I imagine not all)will have in there informed consents that hospice staff do not perform CPR for patients--hospice nurses can essentially be conscientious objectors to CPR. So...should a patient's heart/breathing stop and they receive CPR this would be an implied revocation and the patient would be discharged from hospice. At the hospice's that I have worked at, should a patient be at home and "code" our nurse would call 911 but not necessarily perform CPR. In inpatient hospice units the nursing staff would not automatically "code" the patient but rather would transfer the patient to the emergency room. I don't know if my explanation is going to be user friendly but that is the essential phiolosphyTbolden (talk) 16:45, 21 March 2009 (UTC)

Ok, regarding point 2, while I am not totally sure of the difference in wording with respect to diagnosing illnesses, I think I see where he is going and basically agree. Perhaps this would work "In keeping with the philosophy of hospice, most hospice providers as a matter of policy do not perform diagnostic tests. Patients who request intensive testing of a hospice related diagnosis would usually be discharged from hospice and can be re-admitted at a later date when diagnostics are completed." BTW, I did add hospice related diagnosis because a patient may receive diagnostics to there hearts content (pun intended) for a problem which is unrelated to hospice.Tbolden (talk) 16:52, 21 March 2009 (UTC)

Regarding hastening of death, I can site other hospice web sites which state there goal is not to hasten death. So I would say the goal of hospice is definitely not to hasten death and to state otherwise would be a POV debate probably best left elsewhere. Should I cite the source regarding hastening of death?Tbolden (talk) 16:56, 21 March 2009 (UTC)

Now that all this is here and clear, I'm going to see what I can come up with for sourcing. I'll place it here, so we can talk about it before making any changes. :) (Colored boxes are pretty, aren't they?) --Moonriddengirl (talk) 16:21, 22 March 2009 (UTC)[reply]

Potential ways of addressing this[edit]

What the article could say

The goal of all hospice agencies in the United States is to provide comfort to the patient.[1] How comfort is defined is up to the patient or, if the patient is incapacitated, the patient's family. This can mean freedom from physical, emotional, spiritual and/or social pain. Hospices typically do not perform treatments that are meant to diagnose or cure an illness,[2] and they do not seek to hasten death or, primarily or unduly, to extend life.[3][4][5][6] While it is not required that patients sign "Do not resuscitate" orders to be on hospice, some hospices do require them as a condition of acceptance.[7] Many hospice patients, though not all,[8] have made decisions not to receive CPR should their heart or breathing stop. If a patient does decide to request CPR, that service may not be provided by the hospice; the family may need to contact Emergency Medical Services to provide CPR.[9] The decision not to extend life as well as the pulling back of diagnostic or curative treatments is often the greatest barrier for patients in accepting hospice care; it can also create conflicts in medical professionals attempting to provide it.[10]

Some confusion exists as to what treatments a patient may receive and still qualify for hospice care. Hospices may provide treatments that have been traditionally regarded as curative, including radiation therapy or antibiotics, if these are administered to improve quality of life.[11][12] Determination of appropriate treatment is made on a case-by-case basis.

Another aspect of the hospice philosophy is the patient-centered care they provide. As the focus throughout the United States has shifted from provider-centered care, many healthcare agencies market themselves as patient-centered; for hospice, this patient-directed care is integral and interwoven throughout the care which is provided,[13] and Medicare regulations reflect this philosophy.

References

  1. ^ Aiken, Lewis R. Dying, Death, and Bereavement. Allyn and Bacon. p. 214. ISBN 0205082513.
  2. ^ Old and Swagerty, 8.
  3. ^ Plocher and Metzger, 122.
  4. ^ Rose, Susannah (2004). 100 Questions & Answers about Caring for Family Or Friends with Cancer. Jones & Bartlett Publishers. p. 169. ISBN 0763723614. Hospice is a type of care focusing on improving or maintaining quality of life, as opposed to extending life....
  5. ^ Rosdhahl, Caroline Bunker (2007). Textbook of Basic Nursing (9 ed.). Lippincott Williams & Wilkins. p. 1569. ISBN 0781765218. Hospice care does not speed death, nor does it unduly prolong life...Assisted suicide and euthanasia are not components of hospice care in the U.S. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  6. ^ This is an approach historically mirrored in hospice providers in England. Cf. Gormally, Luke (1992). The Dependent elderly: autonomy, justice, and quality of care. Cambridge University Press. p. 167. ISBN 0521415314. The work of a hospice is aimed not primarily at extending life but at making it more comfortable by palliative care.
  7. ^ Wilbur, Jason K. (2008). Family Medicine Examination and Board Review (2 ed.). McGraw Hill Professional. p. 849. ISBN 0071496084. Despite popular belief, a hospice patient need not agree to a DNR status upon receiving the hospice benefit; however, hospice agencies are permitted to have different admission criteria and some require a DNR status for admission. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  8. ^ Kinzbrunner, Barry M. (2002). 20 Common Problems in End-of-life Care. McGraw-Hill Professional. p. 308. ISBN 0070348839. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  9. ^ "Do not resuscitate (DNR) orders, power of attorney forms, advanced directives and patient comfort". Hospice Patients Alliance. Retrieved 2009-03-22. Hospices cannot force you to sign a DNR form, but hospice staff are not employed to perform CPR...the very heart of hospice is to keep the patient comfortable, but neither to "treat" the disease nor prolong life. In some hospices, the family itself must call the EMS (emergency medical system) if they wish to have EMS personnel resuscitate the patient.
  10. ^ Sugarman, Jeremy (2000). 20 Common Problems Ethics in Primary Care. McGraw-Hill Professional. p. 122. ISBN 007063369X. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  11. ^ Birmingham, Jacqueline Joseph (2005). End-of-life Care: Case Studies and Cost Efficiencies to Help Case Managers Determine Appropriate Levels of Care. HC Pro, Inc. p. 102. ISBN 1578395526. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  12. ^ Wilbur and Graber, 850.
  13. ^ Kilpatrick, Anne Osborne (1999). Handbook of Health Administration and Policy. CRC Press. p. 376. ISBN 0824702212. {{cite book}}: Unknown parameter |coauthor= ignored (|author= suggested) (help).
  • In the first pass, I have removed the "In keeping with this", as it's not entirely necessary (though it's a nice stylistic element), and I have added a sourced note that the family might have to call EMS itself. --Moonriddengirl (talk) 17:00, 22 March 2009 (UTC)[reply]
  • In the second pass, I rearranged the material a little bit and added a note that hospitals are allowed to require DNR status, with sourcing. --Moonriddengirl (talk) 17:23, 22 March 2009 (UTC)[reply]
  • I added "primarily" to the "extending life" bit and a source to support this. I've found another one, but it may be too old to be useful and it's British. :) I'm about to add that, too, as a footnote comment rather than a reference. --Moonriddengirl (talk) 17:43, 22 March 2009 (UTC)[reply]
  • I tend to wonder if most of the rest of the concern with this section could be simply alleviated by changing the subtitle "Philosophy and goals" to "Philosophies and practices". Practices doesn't suggest "this is the way hospice wants it to be" but "this is the way hospice is", and that's ever so much easier to prove. :) What do you think? --Moonriddengirl (talk) 18:03, 22 March 2009 (UTC)[reply]
  • Good to see you on and active. :) I see you're okay with changing the section name. After you finish your edits to the article, please let me know if the proposed text in the orange box works for you. --Moonriddengirl (talk) 19:16, 22 March 2009 (UTC)[reply]
  • Great! Looks like we're almost ready, then, for evaluation. I am very interested in hospice, but honestly I knew almost nothing about it before I met this article and subsequently you. I've been inspired to put as much into this article as I have because of all you did. It was very impressive and inspirational to me to see somebody with no Wikipedia experience work so hard to provide good quality content. :) --Moonriddengirl (talk) 19:37, 22 March 2009 (UTC)[reply]
    I know I've added a lot of references to this article, but I could not have come up with the structure. That comes down to your thorough knowledge of the subject. Most of what I added was built off of that. --Moonriddengirl (talk) 19:38, 22 March 2009 (UTC)[reply]

Question[edit]

Your cousin tells me that one of the sentences in the change isn't sitting well with you. I'm wondering after reviewing your notes if it's related to the DNR, since I'm now gathering that DNR may be connected to "code". :) I've got two 2008 sources that refer to hospices requiring DNR, but I see that the Hospice Conditions of Participation was updated in June 2008. I haven't scanned through that (long!) document yet, but it's here. Is there something in there that renders that information out of date? --Moonriddengirl (talk) 20:18, 22 March 2009 (UTC)[reply]

I can't find anything, but I don't know where to look, and I wouldn't necessarily recognize the terminology if I did, given that I didn't know that "code" and "DNR" might be related until a few minutes ago. :) If it should be that the law has changed, it's no big deal; we can simply alter the current sentence to read something like, "While since whateverdate the United States Department of Health and Human Services has required that Medicare-hospices and Medicaid-certified hospices may not refuse admission to patients who do not wish to sign "Do not resuscitate" orders, in the past some hospices did require them as a condition of acceptance." We just need to straighten out the sourcing, because my method is not good at finding the needle in the haystack. Google books just randomly throws stuff at me and doesn't say, "Oh, but this one is outdated." :) --Moonriddengirl (talk) 20:33, 22 March 2009 (UTC)[reply]

Congratulations![edit]

Your first and thus far only article is a GA. That's pretty stellar. :) --Moonriddengirl (talk) 22:55, 22 March 2009 (UTC)[reply]

By the way, why don't you make a userpage? You can put this on it, if you'd like:
This user helped promote Hospice care in the United States to good article status.

(Copy the whole code, brackets and all; you can see it when you edit this section). If you want to take this through FA review, I'm game to help, but I think that most of the preliminary work would be easier for you. :) Our kind GA reviewer suggested more recent statistics. Can you get hold of these in industry publications? I've found the most recent stats I can find. And we do need an image or two. This one can progress slowly, as there's no time crunch here. Once we enter FA, it'll be wait...wait...wait...hustle! all over again. :) --Moonriddengirl (talk) 23:06, 22 March 2009 (UTC)[reply]

Yes, I think we could. :) I can't say for sure, though. I've never been through the FA process, which I imagine will be high stress. Check out the Wikipedia:Featured article criteria.
If we decide to do that, though, I think we should be ready to go. We need to be careful at this point what more we add to the article, since it's pushing length already. But it would be great if you could get your hands on recent facts and figures if you can, or at least have them handy. I also think we need to be prepared for the process to hurt, since it's possible that reviewers could be very critical of issues like tone and writing style. It takes a thick skin to go through that process of peer review. :) If we make it, we get a bronze star on the article and we run a chance of being featured on the front page. If that happens, a whole lot of people will read the article.
A few images would be helpful. Other than the interior of a room, I'm not sure what else to use. :/ I wrote a corresponding article on Hospice, and I've decorated it with a few international hospices that I found free licensed images for. Do you happen to have any other hospice director friends who might be willing to give you a few pictures? We could use maybe the shot of a hospice agency or an historically significant hospice or hospice ward. I found some nice pictures of hospice patients, but they weren't free licensed, and there are possible privacy issues. Frankly, I'm not sure how we go about proving we have permission of a subject. I'm not very visual, so perhaps you'll have better ideas for what would make a good picture than I will. :) It would be great if we had a picture of one of the historic hospices mentioned in the history & statistics section, but I can't find one. Obviously, a children's hospice picture would be a good one for that section. A picture of one of the team members in action could work in the "Team members" section--something along the lines of this, maybe. It's also possible we could create a pie chart, perhaps, documenting hospice demographics. I might be able to draw together age statistics and whatnot, but we can't use a preexisting chart without a free license, and we'll have to be careful not to create a derivative one. :) --Moonriddengirl (talk) 11:18, 23 March 2009 (UTC)[reply]
In terms of permission what we are working on will be a letter from the CFO of compassionate care on CC letterhead releasing the images (need to make a list) under GFDL with explicit clause for use on wikipedia. I think that will do it. Still closing the loop. jbolden1517Talk 13:47, 23 March 2009 (UTC)[reply]
Letterhead will do, but if you have an e-mail address associated with the website, it's quicker. :) See Wikipedia:Donating copyrighted materials. I'm a neophyte but have recently joined the OTRS Team, so I help handle those e-mails and may be able to clarify questions if you have any about the process. --Moonriddengirl (talk) 13:53, 23 March 2009 (UTC)[reply]

←Sounds good to me. :) --Moonriddengirl (talk) 14:44, 23 March 2009 (UTC)[reply]

No problem; take your time. We can proceed at a leisurely pace right now. :D --Moonriddengirl (talk) 16:36, 23 March 2009 (UTC)[reply]
Sorry. I had a busy work week at the beginning of last week and capped it off with an unanticipated surgery in my household. :) I'm not really sure how many images are good. Let me see if I can whip up a chart or something to graphically demonstrate some of the data in the article. That could help with relevant images. (Whip up won't be as quick as text for me; I'm not naturally artistic and, sadly, lack even photoshop on this computer. :/) --Moonriddengirl (talk) 21:00, 30 March 2009 (UTC)[reply]

Question[edit]

Hi. Good to see you! Occasionally I think about putting that article up for "featured" status. So far haven't been brave enough to launch it. :) Ask away. If the question is private, you can e-mail me by following the link in the "toolbox" on the side of my userpage. :) --Moonriddengirl (talk) 22:18, 6 January 2010 (UTC)[reply]

Not bothering me at all. :) I appreciate your letting me know. I'm not on my e-mail anywhere near as often as I am on Wikipedia. I try to check in at least once a day, but don't always make it! I'll go look for your note. :) --Moonriddengirl (talk) 15:43, 8 January 2010 (UTC)[reply]
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