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Rights Risk and Restraint Free Care of Older People
Person Centred Approaches in Health and Social Care
1st Edition Rhidian Hughes Digital Instant Download
Author(s): Rhidian Hughes, Baroness Greengross
ISBN(s): 9781843109587, 1843109581
Edition: 1
File Details: PDF, 1.06 MB
Year: 2010
Language: english
Rights, Risk and
Restraint-Free Care
of Older People
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Rights, Risk and
Restraint-Free Care
of Older People
Person-Centred Approaches in Health and Social Care

Edited by Rhidian Hughes

Foreword by Baroness Greengross

Jessica Kingsley Publishers

London and Philadelphia
First published in 2010
by Jessica Kingsley Publishers
116 Pentonville Road
London N1 9JB, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA

www.jkp.com

Copyright © Jessica Kingsley Publishers 2010

All rights reserved. No part of this publication may be reproduced in any material form (including
photocopying or storing it in any medium by electronic means and whether or not transiently or
incidentally to some other use of this publication) without the written permission of the copyright
owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988
or under the terms of a licence issued by the Copyright Licensing Agency Ltd, Saffron House,
6–10 Kirby Street, London EC1N 8TS. Applications for the copyright owner’s written permission
to reproduce any part of this publication should be addressed to the publisher.

Warning: The doing of an unauthorised act in relation to a copyright work may result in both a
civil claim for damages and criminal prosecution.

Library of Congress Cataloging in Publication Data

Rights, risk, and restraint-free care of older people : person-centred approaches in health and social
care / edited by Rhidian Hughes ; foreword by Baroness Greengross.
p. ; cm.
Includes bibliographical references.
ISBN 978-1-84310-958-7 (alk. paper)
1. Nursing home patients--Restraint . I. Hughes, Rhidian.
[DNLM: 1. Health Services for the Aged. 2. Restraint, Physical. 3. Aged. 4. Patient Rights. 5.
Patient-Centered Care. 6. Risk Factors. WT 31 R571 2010]
RC954.3.R54 2010
362.16--dc22
2009023158

British Library Cataloguing in Publication Data

A CIP catalogue record for this book is available from the British Library

ISBN 978 1 84310 958 7

ISBN pdf eBook 978 0 85700 222 8

Printed and bound in Great Britain by

Athenaeum Press, Gateshead, Tyne and Wear
 for

Cariad
11 September 2008
 Contents

List of acronyms and abbreviations 11

Foreword 13
Baroness Greengross, International Longevity Centre, UK

Preface 16
Rhidian Hughes, Guy’s, King’s and St Thomas’ School of
Medicine and King’s College London

Chapter 1 Introduction 18
Rhidian Hughes

Part I Types of Restraint, Patterns and Trends 29

Chapter 2 Physical Restraint and Medical Interventions 30
David Evans, University of South Australia

Chapter 3 Covert Medication and Chemical Restraint 41

Carmel M. Hughes, Queen’s University Belfast, and Kate L.
Lapane, Virginia Commonwealth University

Part II Perspectives across Health and

Social Care 55
Chapter 4 Pennsylvania’s Non-Restraint Approach to
Psychiatric Care and Services 56
Gregory M. Smith, Allentown State Hospital, Pennsylvania,
Donna M. Ashbridge, Danville State Hospital, Pennsylvania,
Aidan Altenor, Pennsylvania Department of Public Welfare,
and Robert H. Davis, Office of Mental Health and Substance
Abuse Services, Pennsylvania
Chapter 5 Restraint: The US Nursing Home Perspective 63
Beryl D. Goldman, Kendal Outreach, Pennsylvania, Joan Ferlo
Todd, US Food and Drug Administration, and Janet Davis and
Karen Russell, Pennsylvania Restraint Reduction Initiative

Chapter 6 Ethical Dilemmas in Maintaining Enteral

Feeding: The Use of Hand-Control Mittens 71
Jane Williams, Portsmouth Hospitals NHS Trust

Chapter 7 Do We Need Drugs? Strategies to Reduce

the Over-Prescription of Drugs in Care
Homes Supporting People with Dementia 78
Sheena Wyllie, Barchester Healthcare

Chapter 8 The Therapy of Companionship 84

Jim Ellis, dementia care volunteer

Chapter 9 Health and Safety Perspectives 89

Stephen Clarke, independent training consultant

Chapter 10 Human Rights Perspectives 97

Rhidian Hughes

Part III Issues and Innovations 105

Chapter 11 Clinical-Ethical Considerations on the Use of
Physical Restraint 106
Chris Gastmans, Catholic University of Leuven, Belgium

Chapter 12 Changing Restraint Use: Discourses on

Restraint 120
Kate Irving, Dublin City University

Chapter 13 Therapeutic Approaches and De-Escalation

Techniques 133
Suparna Madan, University of Calgary, Alberta, and
Pat Rowe, Alberta Health Services, Calgary, Alberta
Chapter 14 Wander-Walking and People with Dementia 148
Jan Dewing, East Sussex Community Health PCT and
Canterbury Christchurch University, Kent and Heather
Wilkinson, University of Edinburgh

Chapter 15 Preventing Falls and Avoiding Restraint 167

Samuel R. Nyman, University of Reading, and
David Oliver, City University, London

Chapter 16 Using Evidence-Based Knowledge to

Avoid Physical Restraint 178
Sascha Köpke, University of Hamburg, Gabriele Meyer,
University of Witten-Herdecke, Anja Gerlach, University of
Hamburg, and Antonie Haut, University of Witten-Herdecke

Chapter 17 Reducing Restraint – The Benefits of

Education and Training 193
Ingelin Testad and Dag Aarsland, University of Bergen

Select Bibliography 207

Rhidian Hughes

Afterword 210
Barbara Pointon, Ambassador for the Alzheimers Society
and for the charity ‘for dementia’
About the Contributors 213

subject index 219

Author Index 222

List of Tables, Figures and Boxes
Table 3.1 The average number of drugs received by nursing home
residents in selected countries 42
Table 3.2 Examples of psychoactive medications and their licensed
indications 43
Figure 5.1 Drawings of potential entrapment in hospital beds 66
Figure 6.1 Hand-control mitten 75
Table 9.1 Examples of physical and non-physical challenging
behaviours 91
Box 11.1 Examples of interventions to reduce physical restraint 113
Box 11.2 Recommended measures when using physical restraint 115
Figure 13.1 Behaviour mapping tool 135
Figure 13.2 NO RESTRAINT mnemonic 136
Box 14.1 The phenomenon of wandering 151
Box 17.1 Relation-related care (RRC): An innovative education and
training programme to reduce the use of restraint 195
Table 17.1 Modules and content of the two-day training seminar 196
Table 17.2 Summary of seven-step guidance group 196
Figure 17.1 Continuum of autonomy 200
Figure 17.2 The situated context of restraint 201
Figure 17.3 The relationship between older people and care staff 202
Figure 17.4 Restrain or refrain? The decision-making process 204
 List of acronyms and abbreviations

AAOS American Academy of Orthopaedic Surgeons

ACE Acute care for elders (unit)
ADLs Activities of daily living
AGS American Geriatrics Society
APPG All-Party Parliamentary Group on Dementia
AT Assistive technology
BGS British Geriatrics Society
BIHR British Institute of Human Rights
BPSD Behavioural and psychological symptoms of dementia
CABG Coronary artery bypass graft
CAT Clinical assessment tool
CCTV Closed circuit television
CHIPP Community Hospital Integration Program Project
CI Confidence interval
CMS Centers for Medicare and Medicaid Services
CSCI Commission for Social Care Inspection
CSDD Cornell Scale for Depression in Dementia
CSP Community Support Planning
DH Department of Health
EBN Evidence-based nursing
ECT Electroconvulsive therapy
FDA Food and Drug Administration
FOOD Feed Or Ordinary Diet (trial)
GDS Geriatric Depression Scale
GP General practitioner
GPS Global positioning system
GRADE Grading of Recommendations Assessment, Develop�ment and
Evaluation
HCFA Health Care Financing Administration
HCHC House of Commons Health Committee
HELP Hospital Elder Life Program

11
 Rights, Risk and Restraint-Free Care of Older People

HRA Human Rights Act

HSE Health and Safety Executive
JCHR Joint Committee on Human Rights
MHRA Medicines and Healthcare products Regulatory Agency
MMSE Mini Mental Status Examination
MRI Magnetic resonance imaging
NHS National Health Service
NMC Nursing and Midwifery Council
NPSA National Patient Safety Agency
OBRA 87 Omnibus Budget Reconciliation Act of 1987
PERT Psychiatric emergency response teams
PRN Pro re nata (as required)
RCN Royal College of Nursing
RCT Randomised controlled trial
RNAO Registered Nurses’ Association of Ontario
RRC Relation-related care
SIGN Scottish Intercollegiate Guidelines Network
SSRI Serotonin reuptake inhibitor
STAT Statim (immediately)
UK United Kingdom
UN United Nations
US United States
WHO World Health Organization

12
 Foreword

The ageing of the world’s population is something to be widely celebrated,

but we have to acknowledge the fact that it presents us with certain problems
that have never before been experienced. We need to learn how to deal with
situations which have not been thought about very much until recently.
Restraint is one such issue. This is, therefore, an extremely important book.
It covers a range of issues in a balanced way, drawing on evidence from
various professions and on expertise and experience from many different
countries. Restraint is a critically important and often neglected issue, which
can take many forms and be used in various situations to control people
who are physically ill, those with mental health problems, people in prison
or even in their own home, but the book focuses primarily on older people,
especially those suffering from dementia and at the particular difficulties
they face, as do those people whose role it is to care for them.
The issue of the restraint of older people has been long neglected
and this comprehensive publication covers research, policy and practice. It
draws on social theory and gives many practical examples, while covering
a whole range of ethical issues, including decision making at the end of
life.
It is only since the 1980s that this issue has been taken seriously, so
focusing on restraint, including whether it is ever permissible and, if so,
when, is crucially important, as is an understanding of where the line is to
be drawn between restraint and abuse. Attention is drawn to the potential
use of the tool of human rights, with its emphasis on dignity and the respect
of the individual, which can be very useful in combating the negative
attitudes towards older people that sadly often still prevail. The historical
thread weaving through the book and the range of views explored remind
me of the gradually changing attitudes towards the use of physical restraint
and the punishment of children, which have been studied for much longer.
These chapters give us the opportunity to decide for ourselves where, in
our experience, the danger to an individual older person or the risk to a
member of staff might mean that some form of restraint, used in a strictly

13
 Rights, Risk and Restraint-Free Care of Older People

limited way when a person’s behaviour is exceptionally challenging, as a

tool of last resort, is legitimate. Similarly, we read about situations where
it is never permissible as it has slipped over the boundary into the area of
abuse or the denial of an older person’s rights as a human being. These
difficult boundaries are illustrated in many ways, such as through the use
of psychotropic drugs to deal with seriously difficult or violent behaviour.
In such situations the boundary between acceptable or abusive treatment is
difficult to establish.
A historical perspective throws light on how medicine has often been
misused and how frequently various forms of physical restraint have been
used in care institutions. The book also demonstrates how legislation that
is well thought out can be an important means of combating the misuse
of control, which underlies much of the need for restraint. We learn how
important good staff training and an effective organisational culture can
be in preventing any slip towards abusive behaviour. Above all we gain
an understanding of how quality staff leadership, illustrated by many
examples, can reduce the need for restraint. The importance of monitoring
practice, of increasing transparency and the collection of data to measure
improvement, is highlighted.
Above all we learn how a person-centred approach and the building of
one-to-one relationships can reduce the excessive use of drugs and other
questionable practices.
The ethical basis underlying our values is well illustrated through
drawing out the key principles which must guide practice and how care
workers must always ask themselves who is intended to benefit from any
restraint which is introduced, and whether the beneficiary is the older
person or the staff directly involved. The need to work in the best interests
of people lacking capacity is rightly emphasised.
Other ethical problems are illustrated and the difficulties when having
to restrain people from resisting feeding tubes or using bed rails when
attempting to reduce falls, to the danger of infantilising people when
blocking their movements, are well demonstrated.
Overall, the book invites us to consider whether the best way to
limit the use of restraint is by always considering the motivation of the
restrainer. At a time when the numbers of people suffering from dementia
and other age-related diseases are fast rising such issues need to be spoken
about much more openly. It is only through open debate that we can gain
a greater understanding of when such treatment can be justified and how
any use of restraint must be set in the context of ageist attitudes which are
still so prevalent in our society.

14
 Foreword

This book should go a long way in helping those at the cutting edge of
care services and everyone who considers the future of our ageing society
to think deeply about what their response would be if faced with the very
difficult situations illustrated in this book. We all need to ensure that our
decisions are made in a compassionate and humane way, without in any
way seeking to avoid the dilemmas which are inevitably often involved.
I hope this book will be widely read. It encourages us to question our
motives if ever we are faced with difficult situations when caring for people
to whom it is sometimes very difficult to relate, but who nevertheless need
our care and understanding at the most vulnerable period of their lives, as
they draw to a close.
Baroness Greengross,
Crossbench Peer, House of Lords, Chief Executive,
International Longevity Centre, UK

15
 Preface

In its broadest sense, restraint is about preventing individuals from doing

something they wish to do, including placing limits on people’s will or
ability. There are a host of issues and perspectives to consider if we are to
have an intelligent debate about the use of restraint. The practice tends to
grab the media spotlight and it is not uncommon for coverage to centre on
the abuse of an individual or group of older people, typically living in care
or nursing homes, or during a stay in hospital. When we hear or read about
the restraint of older people strong feelings can be raised. Few would deny
that restraint is a challenging and uncomfortable topic. At a time in older
people’s lives when they often need to be treated with the utmost dignity
and respect, restraint can be viewed as an affront to basic human rights.
A balanced debate about restraint requires a meaningful understanding
about the ways in which older people’s freedoms are restricted and the
effect this has on older people themselves. Crucially, there is an important
balance to be struck between care, freedom, safety and risk. Clearly, at the
centre of the debate should be the perspectives of older people alongside
family members and carers, providers, commissioners and regulators of
health and social care.
This book is the first to take a wide view of restraint and to blend
reviews and analysis of research and policies, multi-disciplinary perspectives
and direct accounts from practice. To these ends the perspectives of those
working across health and social care are captured. The contributions
cover a great deal of ground but are not standardised, for it is the mix and
differences in views, explanations and evidence that are important. The
book aims to share what is known, suggests what else needs to be known
and where the future might lie in dealing with critical and unresolved
issues and tensions. In doing so it is hoped that it will help health and
social care professionals, students and those working in research and policy
to better understand the complexity of the ethical issues raised.
This book is also important in seeking to redress the balance between
the comparably large body of research that is directed to managing
disturbed and challenging behaviour in the fields of mental health, learning
disabilities and criminal justice when, arguably, much less is known about

16
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Review 1: Study tips and learning strategies

Learning Objective 1: Critical analysis and evaluation
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 2: Historical development and evolution
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 2: Diagram/Chart/Graph]
Learning Objective 3: Problem-solving strategies and techniques
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 4: Comparative analysis and synthesis
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Learning Objective 5: Fundamental concepts and principles
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 5: Assessment criteria and rubrics
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Assessment criteria and rubrics
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 7: Critical analysis and evaluation
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 8: Current trends and future directions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Case studies and real-world applications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Exercise 2: Comparative analysis and synthesis
Example 10: Key terms and definitions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Literature review and discussion
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 12: Interdisciplinary approaches
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 13: Diagram/Chart/Graph]
Example 13: Current trends and future directions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 14: Diagram/Chart/Graph]
Note: Current trends and future directions
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 15: Diagram/Chart/Graph]
Note: Research findings and conclusions
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Statistical analysis and interpretation
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Comparative analysis and synthesis
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 18: Diagram/Chart/Graph]
Practice Problem 18: Case studies and real-world applications
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Remember: Theoretical framework and methodology
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 20: Diagram/Chart/Graph]
Test 3: Problem-solving strategies and techniques
Important: Historical development and evolution
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Learning outcomes and objectives
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Practical applications and examples
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Ethical considerations and implications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 24: Diagram/Chart/Graph]
Example 24: Study tips and learning strategies
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Current trends and future directions
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 26: Assessment criteria and rubrics
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Statistical analysis and interpretation
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Case studies and real-world applications
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 29: Comparative analysis and synthesis
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice 4: Assessment criteria and rubrics
Key Concept: Theoretical framework and methodology
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 31: Current trends and future directions
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Comparative analysis and synthesis
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Comparative analysis and synthesis
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 34: Diagram/Chart/Graph]
Remember: Critical analysis and evaluation
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 35: Diagram/Chart/Graph]
Definition: Research findings and conclusions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Practical applications and examples
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 37: Diagram/Chart/Graph]
Definition: Research findings and conclusions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 38: Case studies and real-world applications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 39: Diagram/Chart/Graph]
Definition: Critical analysis and evaluation
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Quiz 5: Comparative analysis and synthesis
Key Concept: Practical applications and examples
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 41: Diagram/Chart/Graph]
Definition: Problem-solving strategies and techniques
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 42: Diagram/Chart/Graph]
Key Concept: Case studies and real-world applications
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Comparative analysis and synthesis
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 44: Experimental procedures and results
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Statistical analysis and interpretation
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 46: Theoretical framework and methodology
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Interdisciplinary approaches
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 48: Diagram/Chart/Graph]
Definition: Literature review and discussion
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 49: Diagram/Chart/Graph]
Important: Best practices and recommendations
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
References 6: Experimental procedures and results
Definition: Best practices and recommendations
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Study tips and learning strategies
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Critical analysis and evaluation
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Theoretical framework and methodology
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 54: Diagram/Chart/Graph]
Definition: Problem-solving strategies and techniques
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 55: Study tips and learning strategies
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Ethical considerations and implications
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 57: Experimental procedures and results
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Fundamental concepts and principles
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 59: Historical development and evolution
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Lesson 7: Theoretical framework and methodology
Definition: Interdisciplinary approaches
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 61: Practical applications and examples
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 62: Experimental procedures and results
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Best practices and recommendations
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Statistical analysis and interpretation
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 65: Key terms and definitions
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Practical applications and examples
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Ethical considerations and implications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 68: Diagram/Chart/Graph]
Important: Key terms and definitions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 69: Practical applications and examples
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Results 8: Learning outcomes and objectives
Important: Problem-solving strategies and techniques
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 71: Diagram/Chart/Graph]
Remember: Case studies and real-world applications
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Historical development and evolution
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 73: Diagram/Chart/Graph]
Example 73: Interdisciplinary approaches
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Example 74: Research findings and conclusions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Learning outcomes and objectives
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Current trends and future directions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 77: Theoretical framework and methodology
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 78: Interdisciplinary approaches
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Study tips and learning strategies
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Unit 9: Comparative analysis and synthesis
Remember: Historical development and evolution
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Historical development and evolution
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Assessment criteria and rubrics
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 83: Diagram/Chart/Graph]
Remember: Learning outcomes and objectives
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Problem-solving strategies and techniques
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Problem-solving strategies and techniques
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Historical development and evolution
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 87: Diagram/Chart/Graph]
Key Concept: Historical development and evolution
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Practical applications and examples
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Literature review and discussion
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 90: Diagram/Chart/Graph]
Module 10: Historical development and evolution
Example 90: Comparative analysis and synthesis
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Ethical considerations and implications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Research findings and conclusions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Ethical considerations and implications
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 94: Diagram/Chart/Graph]
Example 94: Literature review and discussion
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Learning outcomes and objectives
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Comparative analysis and synthesis
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Important: Experimental procedures and results
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Comparative analysis and synthesis
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Study tips and learning strategies
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Introduction 11: Statistical analysis and interpretation
Definition: Literature review and discussion
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 101: Diagram/Chart/Graph]
Practice Problem 101: Statistical analysis and interpretation
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 102: Comparative analysis and synthesis
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Historical development and evolution
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 104: Problem-solving strategies and techniques
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Practical applications and examples
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Best practices and recommendations
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Case studies and real-world applications
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Learning outcomes and objectives
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 109: Assessment criteria and rubrics
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 110: Diagram/Chart/Graph]
Chapter 12: Literature review and discussion
Remember: Practical applications and examples
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 111: Interdisciplinary approaches
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Current trends and future directions
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 113: Theoretical framework and methodology
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Practical applications and examples
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 115: Diagram/Chart/Graph]
Note: Historical development and evolution
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Learning outcomes and objectives
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Learning outcomes and objectives
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Literature review and discussion
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 119: Diagram/Chart/Graph]
Example 119: Literature review and discussion
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Results 13: Theoretical framework and methodology
Remember: Best practices and recommendations
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 121: Experimental procedures and results
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 122: Diagram/Chart/Graph]
Definition: Study tips and learning strategies
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Assessment criteria and rubrics
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 124: Diagram/Chart/Graph]
Important: Literature review and discussion
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Interdisciplinary approaches
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Theoretical framework and methodology
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 127: Diagram/Chart/Graph]
Practice Problem 127: Ethical considerations and implications
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 128: Comparative analysis and synthesis
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 129: Study tips and learning strategies
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Introduction 14: Study tips and learning strategies
Remember: Best practices and recommendations
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
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