Developmental Milestones for Children PDF

WEEK 13: DEVELOPMENTAL MILESTONE NCMA217 – CARE OF MOTHER &CHILD ADOLESCENT FIRST SEM (FINALS) DEVELOPMENTAL MILESTONE  he sees your smile, and  A developmental milestone is a skill that a child learn...

WEEK 13: DEVELOPMENTAL MILESTONE NCMA217 – CARE OF MOTHER &CHILD ADOLESCENT FIRST SEM (FINALS) DEVELOPMENTAL MILESTONE  he sees your smile, and  A developmental milestone is a skill that a child learns to smile back. acquires within a specific time frame What baby  likes to listen to music  Milestones develop in a sequential fashion can hear  baby loves to hear your voice CHILDREN DEVELOP SKILLS IN FIVE MAIN What baby  baby's hands are opening AREAS OF DEVELOPMENT: can feel up more 1. Cognitive Development  enjoy the feeling of her - ability to learn and solve problems hand in her mouth. 2. Social and Emotional Development How baby  strengthening the muscles - ability to interact with others, including moves in his neck so that he may helping themselves and self-control be able to hold his head up 3. Speech and Language Development on his own - ability to both understand and use language  learning to control the 4. Fine Motor Skill Development muscles in arms and legs - ability to use small muscles, specifically their How baby  uses body language to tell hands and fingers communicates you how she feels about 5. Gross Motor Skill Development what is going on - ability to use large muscles  When she smiles at you, she is inviting you to play CHILDHOOD DEVELOPMENT with her  baby's cries are becoming 12T C WEEK2 easier to identify  Newborns are totally dependent on us for their basic needs 3-C MONTHS What baby can  vision is not fully developed see  enjoy seeing bright colors  baby will smile more often, and begin to or large black and white laugh. pictures What baby can  focus on objects as far see away as three feet What baby can  already recognizes his  can look back and forth at hear mother's voice when he is two different things. born  changes in your baby's How baby eats  begin introducing solid body movements when foods there are new or loud How baby  learns to hold her head up sounds around him. moves on her own What baby can  Babies enjoy gentle  may start to roll over feel massage How baby  can reach and grab things How baby eats  only tolerate liquids uses her hands How baby  need a lot of support to moves hold his head up How baby  begin using different vowel communicates sounds How baby  cry is her way of How baby  more active in getting communicates communicating her needs. growing attention  When baby makes eye emotionally  begin to smile at herself in contact with you, he is the mirror communicating his interest Loving and  enjoy playing peek-a-boo  baby may pull back from playing with  Give lots of opportunities to you to show that he needs baby reach for things with a break. different textures  baby may make cooing sounds, particularly when you talk to her. C-9 MONTHS  beginning to move his body into different 1 ½-3 monTh2 positions. How baby eat  explore the world by  awake for a good part of the day, and sleeping putting things in his mouth most of the night. How baby uses  enjoys learning about his What baby  vision is improving her hands surroundings. can see  starting to look in the  can move a toy easily direction where sounds are from one hand to the coming from other. 1|M I N  How your baby  learning to sit by herself moves  babies love to stand when How your  use lots of energy to learn you hold them up child moves to walk.  She is getting ready to  learn how to roll and kick a crawl. ball. How baby  may turn his head when How child  child is putting two and communicates you call his name. communicates three words together to  He enjoy blowing make simple sentences "bubbles" and makes How your  more interested in turning "bbb" sounds. child explores pages of her favorite books How your baby  If you hide baby's bottle  learn how to match two explores and she sees where you objects together by color, put it, she may try to shape or size. reach for it  paying more attention to the  enjoys repeating an action actions of others over and over. How your  earning how to How baby  communicate with you by child is communicate his wants, responds to using gestures. growing needs, and feelings by others  baby is picking up on emotionally using words and facial feelings by the tone of expressions voice.  begin to recognize herself in the mirror. 9-12 MONTHS  child may show jealousy  very curious and explores his surroundings. when he isn't the center of How baby eats  Begin spoon-feeding attention.  Introduce more solid foods but cut them into tiny, 2-3 years How your  learn how to use his thumb  They want to do things for themselves baby uses her and index finger to pick up How child eats  start the habit of washing hands small objects his hands before meals.  learning to voluntarily let go  capable of helping with of things and will "practice" some meal preparation dropping objects How child uses  more interested in How baby  baby will pull himself up his hands scribbling with crayons moves from the floor to stand  enjoy learning to cut with against a sofa, table safety scissors.  preparing himself to take his How child  learn to jump on both feet first step by himself. moves  to walk up and down stairs How baby  starts to use her pointer independently. communicates finger to show interest in How your child  child will understand something explores simple stories.  when you say "no," baby  child's imagination will may stop what she is doing become more vivid and may even look at you.  Learn to count "1-2-3“  may recognize a few How child  showing more interest in familiar words. growing other children How baby  understand the word "no,“ emotionally  "Mine" is a word often growing  try to imitate some of the used emotionally things that you do  child will know that he is a  baby will only want her boy, or that she is a girl mother to take care of her needs and is more hesitant 3-5 years around strangers.  child believes that everything revolves around her 1-2 years How child eats  capable of helping with  Learning to walk and talk is your child's some meal preparation biggest job in this year. How child  learn to hold his crayon How child eats  child should be on an eating uses his hands better schedule and can join the  learn how to button his family at the dinner table 3 clothes and zip and unzip times a day. by himself How child  trying to use a spoon  offer to help with household uses his  enjoy making marks on chores hands paper with crayons. 2|M I N  How child  learn to throw and catch a  lying, cheating & stealing are all examples of moves large ball behavior  prone to accidents because  Learn how to deal with failure without losing self- she may be more esteem adventurous  They are highly active How your child  Asking "why" is a favorite  They know right from wrong communicates activity  Able to accept moderate responsibilities  learn to listen to the - Ex. Household chores explanations of others with  Has sense of humor interest.  has self-confidence & a sense of pride &  can recite familiar stories competence How child  learn to know different  Has dramatic, artistic or musical talent explores shapes by name and colors  Takes appropriate responsibility for homework  know how to tell a story with little prodding with a beginning, middle,  Assumes responsibility for his or her own health and end.  Is comfortable in asking parents questions How child  develop fears especially  Generally cooperative and considerate, although growing about unfamiliar sights and at times is inconsistent and unpredictable emotionally sounds  easily influenced by what ADOLESCENT he watches on TV.  a time of many transitions for both teens and  earn to follow simple rules their families. in games like "hide and Physical  rapid gains in height and seek" development weight.  development of secondary sex 5-7 years characteristics.  each day becomes an adventure and a time of discovery very curious and explores his Ex: menarche surroundings. o continued brain development. How child eats  capable of measuring o teens frequently sleep longer. ingredients and using o maybe more clumsy because of simple kitchen utensils growth spurts. How child  learn how to make letters, o overly sensitive about their uses his hands words and sentences. weight.  will be able to tie his shoes o concerned because they are How child  be able balance on one not physically developing at the moves foot for 10 seconds. same rate as their peers. o feel awkward about How your child  recognize opposites, define demonstrating affections to the communicates objects by their use opposite sex parent.  understands the rules of o ask more direct questions about conversation sex. How child  be able to follow two-step Cognitive  developing advanced reasoning explores directions development skills  know his full name, age  developing abstract thinking and address skills.  be able to answer who,  demonstrate a heightened level what, when, where, why of self-consciousness. questions.  they believe that no one else How child  Developing self-esteem is has ever experienced similar growing a central issue feelings and emotions emotionally  child is a wonderful mimic  teens tend to exhibit the “it  child is becoming aware can’t happen to me” syndrome that she is one of many also known as “personal fable” people in the world  tends to become very cause –  become very interested in oriented the difference between  tend to exhibit a “justice” truth and lies orientation Psychosocial  establishing an identity SCHOOL AGE development  establishing autonomy  describes the expected physical, emotional & mental abilities  Teens begin to spend more time with their friends than their  Peer acceptance become increasingly important families  Friendship with members of same sex 3|M I N  May have more questions  May become elusive about about sexuality where they are going or with  May begin to keep a journal whom.  When they are in their rooms  More argumentative they may begin lock their bed  Teens may not want to be seen room doors. with parents in public  May become involved in multiple hobbies or clubs 4|M I N WEEK 14: NURSING PROCESS FOR PROMOTION OF NORMAL GROWTH AND DEVELOPMENT NCMA217 – CARE OF MOTHER &CHILD ADOLESCENT FIRST SEM (FINALS) THE FAMILY WITH AN INFANT takes time. Try to suggest activities that can Assessment be easily incorporated into the family’s  Nursing assessment of an infant begins with an lifestyle. interview with the primary caregiver. Important If your assessment data indicate that a child areas to discuss include nutrition, growth needs more exposure to language and you patterns, and development. know both parents work during the day, for  An infant’s height, weight, and head example, you might suggest the parents ask circumference are important indicators of growth, their child’s caretaker to talk to their infant so they should be measured and plotted on more. standard growth charts (Brayden, Daley, & Encourage parents to spend additional time Brown, 2008). These charts represent average each evening reading or reciting nursery growth and can determine if the baby’s growth rhymes to their baby. The combined remains within the same relative percentile at interventions should increase the baby’s each checkup. language skills.  Physical assessment of an infant must be done quickly yet thoroughly because a baby can tire or Implementation become hungry, making it difficult to judge overall One of the most important interventions of the behavior and temperament. infant period is teaching new parents about how  The primary caregiver should be present to make to care for their infant and keep the infant safe. a child feel comfortable. Using a calm approach Whenever possible, this information should be helps the infant remain calm as well. anticipatory so parents can prepare for ways to care for and protect their infant as the infant Nursing Diagnosis grows.  Much of your assessment of an infant and family will focus on basic needs such as sleep, Outcome Evaluation nutrition, and activity and the parents’ adjustment  Evaluate expected outcomes at each visit to to their new role. Examples of nursing diagnoses detect changes in parents’ understanding of are: caring for their infant. Help parents understand all aspects of infant care, not just a single element. Ineffective breastfeeding related to maternal  Examples of expected outcomes include: fatigue Disturbed sleep pattern (maternal) related to Mother states she feels fatigued but able to baby’s need to nurse every 2 hours cope with sleep disturbance from night Deficient knowledge related to normal infant waking. growth and development Parents state five actions they are taking Imbalanced nutrition, less than body daily to encourage bonding. requirements, related to infant’s difficulty Father states both he and spouse are sucking adjusting to new roles as parents. Health-seeking behaviors related to adjusting Parents verbalize appropriate techniques to parenthood they use to stimulate infants. Delayed growth and development related to Infants demonstrate age-appropriate growth lack of stimulating environment and development. Risk for impaired parenting related to long Infant exhibits weight, height, and head and hospitalization of infant chest circumference within acceptable Readiness for enhanced family coping related norms. to increased financial support Social isolation (maternal) related to lack of THE FAMILY WITH A TODDLER adequate social support Assessment Ineffective role performance related to new  Whether a child is seen for a routine checkup or responsibilities within the family has come to a health care center because of a specific health concern, assessment begins with Outcome Identification and Planning taking a careful health history. Asking parents  Outcomes established for infant care need to be about a toddler’s ability to carry out activities of realistic based on the family’s new daily living offers assessment information not only circumstances. on the child’s developmental progress but also important clues about the child–parent Parents of infants, especially first-time relationship. Careful observation is another parents, must do a lot of adjusting, and this crucial element of nursing assessment of a 5|M I N  toddler. This is because parents may become so emotionally involved in a health concern they Parents state child maintains a consistent may not describe it with complete objectivity. On bedtime routine within the next 2 weeks. the other hand, parents see their children daily Parents state they have childproofed their and so are the best source of information and home by putting a lock on kitchen cupboard opinion on when a child seems to be acting “out by next clinic of sorts” or “different” (a typical sign a child may visit. not be feeling well). Grandmother states she has modified usual activities to conserve strength to care for Nursing Diagnosis toddler  Nursing diagnoses related to normal growth and granddaughter by 1 weeks’ time. development of toddlers usually focus on the parents’ eagerness to learn more about the THE FAMILY WITH A PRESCHOOLER parameters of normal growth and development or Assessment issues of safety or care. Examples are:  Regular assessment of a preschooler includes obtaining a health history and performing both a Health-seeking behaviors related to normal physical and developmental evaluation. toddler development Preschoolers speak very little during a health Deficient knowledge related to best method assessment; they may even revert to baby talk or of toilet training babyish actions such as thumb-sucking if they Risk for injury related to impulsiveness of find a health visit stressful. A history that details toddler their usual performance level is therefore very Interrupted family process related to need for important for accurate evaluation. close supervision of 2-year-old  Assess a child’s weight and height according to Readiness for enhanced family coping standard growth charts. Keep in mind these related to parents’ ability to adjust to new charts are based on average weights and heights needs of child of white American children, so those for children Readiness for enhanced parenting related to from other ethnic or cultural backgrounds may increased awareness for poison prevention not completely agree with these norms. Disturbed sleep pattern related to lack of  Also assess a child for general appearance. bedtime routine Does the child appear alert? Happy? Active? Healthy? Ask whether a child can play actively Outcome Identification and Planning without becoming exhausted. Assess the teeth  To help parents resolve a concern during the for presence of cavities. Evaluate for a toddler period, focus largely on family education symmetrical gait. As preschoolers develop and anticipatory guidance. Urge them to establish frequent upper respiratory infections (the average realistic goals and outcomes so they can meet preschooler may have 6 to 12 a year), assess for the rapidly changing needs of their toddler and these as well. learn to cope with typical toddler behaviors. Otherwise, parents can expect too much of a Nursing Diagnosis toddler and grow frustrated instead of enjoying  Nursing diagnoses for preschoolers typically being a parent of a child this age. concern health promotion. Examples are: Implementation Health-seeking behaviors related to When teaching about typical toddler behavior, developmental expectations teach parents a good rule is to think of a toddler Readiness for enhanced parenting related to as a visitor from a foreign land who wants to parent’s pride in child participate in everything the family is doing but does not know the customs or the language. Other nursing diagnoses include: They need to help their toddler learn these the Risk for injury related to increased same as they would that stranger. independence outside the home Also teach parents not only how to approach a Delayed growth and development related to current problem but also how to learn adequate frequent illness methods for resolving similar situations that are Risk for poisoning related to maturational sure to arise in the future. If parents do not learn age of child methods that can be applied throughout their Parental anxiety related to lack of child’s growing years, they may win battles but understanding of childhood development lose wars. Imbalanced nutrition related to child’s many food dislikes Outcome Evaluation  Expected outcomes must be evaluated frequently Outcome Identification and Planning during the toddler period because children  For many parents, preschool is a difficult time change so much and learn so many new skills because a child is at an in-between stage: no during this time that their abilities and associated longer an infant, although not yet ready for formal parental concerns can change from day to day. school.  Examples of expected outcomes are: 6|M I N   During the physical examination, show your Planning and establishing expected respect for children’s adult-level modesty by outcomes for care of the preschooler often furnishing a cover gown. begin with establishing a schedule for  Parents of school-age children often mention discussing normal preschool development behavioral issues or conflicts during yearly health with the parents (this should be done at all visits. Some parents feel they are losing contact health maintenance visits). with their children during these years. This can Planning for accident prevention such as cause them to misinterpret a normal change in how to cross streets safely becomes behavior, especially if they are not prepared for increasingly important as children begin to what to expect from their child. Other parents enjoy experiences away from home. It is may consider children who behave differently important to plan opportunities for from their siblings as “abnormal” when children adventurous activities or messy play. When are just expressing their own personality. asking parents to incorporate adventurous  When problems are discussed in the health care activities or messy material into a setting, take the history from the parent but also preschooler’s play, you may be asking them allow the child to express the problem. It may be to do something they do not personally necessary to obtain the opinion of school enjoy. personnel (with the parents’ permission) Most parents do initiate these activities with regarding the problem or even just determine their child if they believe they are important, whether school personnel feel a problem exists. but some are able to do this better than In some instances, a counselor’s opinion may be others. Allowing children choices may also necessary. If the problem is related to a medical be difficult for parents because they want to condition, its effect on the family should also be protect them from making errors. assessed, because the illness of a child affects the functioning of the entire family. Implementation  Preschool children imitate moods as well as Nursing Diagnosis actions. An important nursing intervention, then,  Common nursing diagnoses pertinent to growth is role playing a mood or attitude you would like a and development during the school-age period child to learn. To project an attitude that health are: assessment is an enjoyable activity, you might suggest preschoolers participate by listening to Health-seeking behaviors related to normal their heart or coloring the table paper. Accident school-age growth and development prevention is also best taught by role modeling (a Readiness for enhanced parenting related to parent always crosses streets at the corner and improved family living conditions does not start the car until seatbelts are in place). Anxiety related to slow growth pattern of child Risk for injury related to deficient parental Outcome Evaluation knowledge about safety precautions for a  Evaluation of expected outcomes needs to be school-age child continuous and frequent. Because growth during Imbalanced nutrition, more than body this period is more cognitive and emotional than requirements, related to frequent consumption physical, parents may report little growth. of snack foods Evaluating specific areas helps them to see that Delayed growth and development related to progress has occurred. Examples of expected speech, motor, psychosocial, or cognitive outcomes might be: concerns Child states importance of holding parent’s Outcome Identification and Planning hand while crossing streets.  When identifying expected outcomes and Parent states realistic expectations of 3- planning care, keep in mind that school-age year-old’s motor ability by next visit. children tend to enjoy small or short-term projects Mother reports she has prepared 4-year-old rather than long, involved ones. A child with for new baby by next visit. diabetes, for example, in her early school years may gain a feeling of achievement by learning to THE FAMILY WITH A SCHOOL AGE CHILD assess her own serum glucose level, but she Assessment may have difficulty continuing glucose  Use both history and physical examination to assessment on a regular basis. assess growth and development of a school-age  Behavior problems need to be well defined child. Include questions about school activities before outcomes are identified and interventions and progress. School-age children are interested planned. Often, it is enough for parents to accept and able to contribute to their own health history; the problem as one consistent with normal to allow for this, it is useful to interview children growth and development. 10 years or older at least in part without their parents present. Implementation  School-age children are interested in learning about adult roles, so this means they will watch you to see your attitude as well as your actions in 7|M I N  a given situation. When giving care, keep in mind Anxiety related to concerns about normal growth children this age feel more comfortable if they and development know the “hows” and “whys” of actions. They may Risk for injury related to peer pressure to use not cooperate with a procedure until they are alcohol and drugs given a satisfactory explanation of why it must be Readiness for enhanced parenting related to done. increased knowledge of teenage years Outcome Identification and Planning Outcome Evaluation  When planning care with adolescents, respect  Yearly health visits covering both physical and the fact they have a strong desire to exert psychosocial development are important at this independence or do things their own way. This age. It may be useful for parents to look back on means they are not likely to adhere to a plan of problems identified at the last visit and discuss if care that disrupts their lifestyle or makes them and how they were resolved. Often, some appear different from others their age. Including problems and conflicts fade away without anyone them in planning is essential so the plan will be really noticing. As some problems recede, agreeable and accepted. Establishing a contract however, others may emerge. At times, the same such as asking an adolescent to agree to take concerns of parents and the child may appear to medication daily may be the most effective be unresolved at each visit. Make sure no means to reach a mutual understanding. underlying problem exists that prevents Adolescents are very present oriented, so a resolution. Examples of expected outcomes program that provides immediate results, such as are: increased respiratory function, will usually be carried out well. In contrast, a regimen oriented Parent states he allows child to make own toward the future, with long-term goals such as decisions about how to spend allowance. preventing hypertension, may not be as Child lists books she and her parents have successful. read together in past 2 weeks. Child states he understands his growth is Implementation normal, even though he is the shortest boy in  Adolescents do poorly with tasks that someone his eighth-grade class. tells them they must do. If they help to plan tasks, Child does not sustain injury from sports however, they can typically carry them out activities during the summer recess. successfully. Adolescents have little patience with adults who do not demonstrate the behavior they THE FAMILY WITH AN ADOLESCENCE are being asked to achieve; a parent or nurse Assessment who smokes and asks an adolescent not to  Parents rarely bring adolescents for routine smoke, for example, will probably not be health maintenance visits the way they did when successful. For best results, evaluate how an their children were younger, and adolescents intervention appears from an adolescent’s generally do not come to health care facilities on standpoint before beginning teaching. their own unless they are ill. Unless adolescents need a physical examination for athletic Outcome Evaluation clearance, therefore, they are often not seen for  Evaluation of expected outcomes should include health assessments. When adolescents are not only whether desired outcomes have been accompanied by their parents a health visits, it is achieved but whether adolescents are pleased best to obtain a health history separately from with their success. Individuals will have difficulty parents to promote independence and accomplishing desired goals as adults unless responsibility for self-care. When performing they have high self-esteem that includes feeling physical examinations on adolescents, be aware secure in their new body image. they may be very self-conscious. They also need  Examples of outcome criteria that might be health assurance and appreciate comments such established are: as “Your hair has a nice, healthy feel,” or “This is an accessory nipple. Have you ever wondered Client states she is able to feel good about about it?” so they can learn more about their herself even though she is the shortest girl in rapidly changing bodies. her class. Client states he has not consumed alcohol in Nursing Diagnosis 2 weeks.  Nursing diagnoses for adolescents cover a wide Parents state they feel more confident about range. Frequently used diagnoses related to their ability to parent an adolescent. adolescents and their families are: Client states she feels high self-esteem despite persistent facial acne. Health-seeking behaviors related to normal growth and development Low self-esteem related to facial acne 8|M I N WEEK 16: ETHICAL SCOPE AND STANDARDS NCMA217 – CARE OF MOTHER &CHILD ADOLESCENT FIRST SEM (FINALS) ETHICS b. These codes are not legally binding, but the I. Description: The branch of philosophy board of nursing has authority in reprimand concerned with the distinction between right nurses for unprofessional conduct that and wrong on the basis of the body knowledge, results from violation of ethical codes. not only on the basis of opinions. VII. Ethical Dilemma II. Morality: Behavior in accordance with a. An ethical dilemma occurs when there is customs or traditions, usually reflecting personal a conflict between two or more ethical or religious beliefs. principles. b. No correct decision exists, and the nurse III. Ethical Principles: Codes that directs or must make a choice between two governs nursing actions alternatives that are equals a result of differences in culturally unsatisfactory. a. Autonomy – respect for an individual’s c. Such dilemma may occur as a result of right to self determination differences in cultural or religious b. Nonmaleficence – The obligation to do beliefs. or cause no harm to another d. Ethical reasoning is the process of c. Beneficence – The duty to do good to thinking through what one should do in others and to maintain a balance an orderly and systematic manner to between benefits and harm. provide justification for action based on Paternalism is an undesirable outcome principles; the nurse should gather all of beneficence, in which the health care information to determine whether an provider decides what is best for the ethical dilemma exists, examine his or client and encourages the client to act her own values, verbalize the problem, against his/her own choices. consider possible courses of action, d. Justice – The equitable distribution of negotiate the outcome, and evaluate the potential benefits and task determining action taken. the order in which clients should be cared for VIII. Advocate e. Veracity – The obligation to tell the truth a. An advocate is a person who speaks up for or f. Fidelity – The duty to do what one has acts on behalf of the client, protects the promised client’s right to make his or her own decisions, and upholds the principle of IV. Values: Beliefs and attitudes that may fidelity. influence behavior and the process of decision b. An advocate represents the client’s making viewpoint to others. c. An advocate avoids letting personal values V. Values Identification: The process of analyzing influence advocacy for the client to support one’s own values to understand oneself more the client’s decision, even when it conflicts completely regarding what is truly important. with the advocate’s own preferences or choices. VI. Ethical Codes a. Ethical codes provide broad principles for determining and evaluating client care. 9|M I N IX. Ethics Committees ETHICAL CONSIDERATIONS OF PRACTICE ON a. Ethics committees takes a multidisciplinary MATERNAL AND CHILD CARE approach to facilitate dialogue regarding Some of the most difficult ethical quandaries in ethical dilemmas. health care today are those that involve children b. These committees develop and establish and families. Examples include: policies and procedures to facilitate the prevention and resolution of dilemmas.  Conception issues, especially those related ton invitro fertilization, embryo transfer, CLIENT’S RIGHTS ownership of frozen oocytes or sperm, and a. The client’s rights document, also called the surrogate motherhood Client’s Bill of Rights, reflects  Pregnancy termination acknowledgement of client’s right to  Fetal rights versus the rights of the mother participate in her or his healthcare with an  Stem cell research emphasis of client’s autonomy.  Resuscitation (and length of continuation) b. The document provides a list of rights of the  Number of procedures or degree of pain a client and responsibilities that the hospital child should be asked to endure to achieve a cannot violate. degree of better health  Balance between modern technology and CLIENT’S RIGHT WHEN HOSPITALIZED quality of life 1. Right to considerate and respectful care  Difficulty maintaining confidentiality of 2. Right to be informed about diagnosis, records when there are multiple care givers possible treatments, likely outcome, and to discuss this information with the health care provider 3. Right to know the names and roles of the persons who are involved in care 4. Right to consent or refuse a treatment 5. Right to have an advance directive 6. Right to privacy 7. Right to expect that medical records are confidential 8. Right to review the medical record and to have information explained 9. Right to expect that the hospital will provide necessary health services 10. Right to know if the hospital with outside parties that may influence treatment or care 11. Right to consent or refuse to take part in research 12. Right to be told of realistic care alternatives when hospital care is no longer appropriate 13. Right to know about hospital rules that affect treatment, and about charges and payment methods 10 | M I N