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Gibbs' Reflective Cycle
One of the most famous cyclical models of reflection leading you through six stages exploring an experience: description, feelings, evaluation, analysis, conclusion and action plan.
Gibbs' Reflective Cycle was developed by Graham Gibbs in 1988 to give structure to learning from experiences. It offers a framework for examining experiences, and given its cyclic nature lends itself particularly well to repeated experiences, allowing you to learn and plan from things that either went well or didn’t go well. It covers 6 stages:
- Description of the experience
- Feelings and thoughts about the experience
- Evaluation of the experience, both good and bad
- Analysis to make sense of the situation
- Conclusion about what you learned and what you could have done differently
- Action plan for how you would deal with similar situations in the future, or general changes you might find appropriate.
Below is further information on:
- The model – each stage is given a fuller description, guiding questions to ask yourself and an example of how this might look in a reflection
- Different depths of reflection – an example of reflecting more briefly using this model
This is just one model of reflection. Test it out and see how it works for you. If you find that only a few of the questions are helpful for you, focus on those. However, by thinking about each stage you are more likely to engage critically with your learning experience.
This model is a good way to work through an experience. This can be either a stand-alone experience or a situation you go through frequently, for example meetings with a team you have to collaborate with. Gibbs originally advocated its use in repeated situations, but the stages and principles apply equally well for single experiences too. If done with a stand-alone experience, the action plan may become more general and look at how you can apply your conclusions in the future.
For each of the stages of the model a number of helpful questions are outlined below. You don’t have to answer all of them but they can guide you about what sort of things make sense to include in that stage. You might have other prompts that work better for you.
Here you have a chance to describe the situation in detail. The main points to include here concern what happened. Your feelings and conclusions will come later.
- What happened?
- When and where did it happen?
- Who was present?
- What did you and the other people do?
- What was the outcome of the situation?
- Why were you there?
- What did you want to happen?
Example of 'Description'
Here you can explore any feelings or thoughts that you had during the experience and how they may have impacted the experience.
- What were you feeling during the situation?
- What were you feeling before and after the situation?
- What do you think other people were feeling about the situation?
- What do you think other people feel about the situation now?
- What were you thinking during the situation?
- What do you think about the situation now?
Example of 'Feelings'
Here you have a chance to evaluate what worked and what didn’t work in the situation. Try to be as objective and honest as possible. To get the most out of your reflection focus on both the positive and the negative aspects of the situation, even if it was primarily one or the other.
- What was good and bad about the experience?
- What went well?
- What didn’t go so well?
- What did you and other people contribute to the situation (positively or negatively)?
Example of 'Evaluation'
The analysis step is where you have a chance to make sense of what happened. Up until now you have focused on details around what happened in the situation. Now you have a chance to extract meaning from it. You want to target the different aspects that went well or poorly and ask yourself why. If you are looking to include academic literature, this is the natural place to include it.
- Why did things go well?
- Why didn’t it go well?
- What sense can I make of the situation?
- What knowledge – my own or others (for example academic literature) can help me understand the situation?
Example of 'Analysis'
In this section you can make conclusions about what happened. This is where you summarise your learning and highlight what changes to your actions could improve the outcome in the future. It should be a natural response to the previous sections.
- What did I learn from this situation?
- How could this have been a more positive situation for everyone involved?
- What skills do I need to develop for me to handle a situation like this better?
- What else could I have done?
Example of a 'Conclusion'
At this step you plan for what you would do differently in a similar or related situation in the future. It can also be extremely helpful to think about how you will help yourself to act differently – such that you don’t only plan what you will do differently, but also how you will make sure it happens. Sometimes just the realisation is enough, but other times reminders might be helpful.
- If I had to do the same thing again, what would I do differently?
- How will I develop the required skills I need?
- How can I make sure that I can act differently next time?
Example of 'Action Plan'
Different depths of reflection.
Depending on the context you are doing the reflection in, you might want use different levels of details. Here is the same scenario, which was used in the example above, however it is presented much more briefly.
Gibbs G (1988). Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford.
Health and Safety Advice in a Fast Changing World
Nurses and Midwives Reflection Process
Nurses and Midwives in the UK are formally required to record 5 pieces of reflection on either continuing professional development (CPD) or practice related feedback to improve their nursing practice.
Here I start with the theory of reflection (see Framework image) and then give an example from my own nursing history of an awful incident – one I will never forget.
If you don’t want the theory (and let’s face it who does?); scroll down to my real-life example and see how I have applied the Gibbs theory model to a terrible incident which almost made me give up nursing.
Let’s Get Started
To see if Gibbs reflective cycle can help you reflect on aspects of your practice, recall a nursing situation that didn’t turn out as you expected or go to plan.
Look at the Gibbs Model flow chart above –
Stage 1 – Description (Pure Facts)
The first step is to describe what you know. Ask yourself the following questions:
- What are the brief facts of the situation?
- What occurred? Who was involved?
- What did you do? What did others do?
Stage 2 – Description – (Feelings)
- How were you feeling at the time?
- Were there influences affecting others actions/behaviour?
- Were there any known or perceived difficulties with the activity, timing, location, information or resources etc.?
Stage 3 – Evaluation
- What was good and bad about the experience
- How might the facts and feelings (from stage 1 and 2 above) have affected your actions/behaviour
- What other circumstances may have affected your actions or thoughts?
- How issues might influence the activity or practice related feedback?
Stage 4 – Analysis
- Why you picked this incident to reflect on?
- What sense can you make of it? Does it make sense given the preceding 3 stages?
- What is the main area of concern or focus on the future?
Stage 5 – Conclusions
- What have you discovered?
- What have you learned from this incident and circumstances?
- What questions remain?
Stage 6 – Now What? (Action)
You have analysed the incident and want to make sure you improve your practice for next time, so need to move into the action planning stage:
- What will I do differently from now on or the next time this arises?
- What resources/help will you need?
Gibbs, (1988) Learning by Doing: A Guide to Teaching and Learning Methods Further Education Unit, Oxford Brookes University, Oxford.
Example Reflection – Sadly, a real story!
Night duty drug round.
I am a third-year student nurse ‘in charge’ on night duty, in a London hospital, with a junior nurse to deal with 23 pretty sick people in this medical ward. A doctor asked me to give a patient (Mrs X,) 0.1 mg of Digoxin (a heart stimulant – steady, slows and strengthens the heartbeat) to relieve symptoms of severe congestive cardiac failure and difficulty breathing. I had never given such a high dose of Digoxin before and measured 4 tabs from the 0.25 mg bottle. I checked the script and the tablets with both the doctor, who nodded, and my junior nurse. We were all in agreement. I checked Mrs X’s pulse rate (standard practice for Digoxin), which was in the OK range, before giving the tablets. I kept Mrs X on hourly observations after.
At about 2 am I suddenly realised I had given 10 times the amount of Digoxin as stated on the Doctors script. In horror, I called the night sister who agreed with me. We filled in an incident form, informed the doctor and Mrs X’s relatives of what happened. Petrified, I was told to go see the hospital matron in the morning.
Mrs X did not seem to suffer any ill effects from the Digoxin during the night and went on to make a full recovery.
I had been on nights for a long stretch. It was a very busy ward with only two-night staff and I was “in charge”. Mrs X was very ill and needed constant monitoring.
I had only ever seen 0.25mgs of Digoxin tablets and did not know there was a paediatric blue table of 0.1 mg made. I was very reluctant to give such a big dose which is why I checked the four tablets of .25 with the doctor who looked at the tablets and said OK. I was nervous about the dosage being so high and took Mrs X’s pulse for much longer than the customary 15 seconds.
The doctor too was under tremendous strain, his beeper kept going off and he was rushing about all over the place. I had never met him before. He had recently come from a paediatric ward.
Nobody ever blamed me for the incident, neither did they reassure me. Mrs X went on to make a full recovery and the relatives were very understanding about the situation which was a relief. Matron was kind to me and impressed I had owned up to the error – nobody would have ever known, she said.
I felt absolutely terrified about the error though and watched Mrs X all night for signs of overdose. I didn’t sleep all the next day and returned to my next night shift to find Mrs X better.
This incident really frightened me because I had done everything right – I had checked the dosage with both the Doctor and the junior nurse. I had not known that you could get a 0.1 mg of Digoxin or it was blue. I have no idea what prompted me to think about the overdose later on that night except that I had been very reluctant to give it. The Doctor agreed I had shown him 4 white tablets who said “I thought you knew what you were doing” Which isn’t any sort of answer really. Yet he didn’t get in trouble (like me) at all for overseeing and agreeing my mistake.
I also realised how dependant patients are on the care and insights of the medical profession and the trust they put in us; I’d let Mrs X down.
I believe that this incident was down to a series of incidents linked to overwork, tiredness and misunderstandings. Plus if I’d known the Doctor better I might have had a conversation about the dose.
I was so relieved that Mrs X survived the overdose and the relatives were understanding but, if she had a serious reaction or even died, I’m not sure I could have carried on nursing.
I have learnt to be more careful with drugs and to really understand the dosage. If necessary now I will look up the drug in the reference books before I give them because it is my responsibility if I do it wrong.
I will always be ultra-careful with new drug scripts in the future and if I am nervous, then to go with my gut feeling and check and check again. Although, as I said to Matron, at the time I’d felt as if I done as much as I could have.
Also, if nurses in my team are involved in incidents where they have made a clinical mistake, I am always on hand to offer support and give them an opportunity to talk to me.
I never want another nurse to go through what I went through alone and I definitely do not want to harm anyone in my care.
Linked to NMC Code of Practice 14 – “Preserving Safety”
- British National Formulary (BNF) the drugs’ bible in the UK, available online with a subscription
Other of my real stories here:
- For a second applied reflection example, see my blog about My Infographic Mistake
- For a third reflection see Dog Walking
I have also published a workbook for nurses where you can see the model and have space to add your own private stories. Available on Amazon. Thanks for reading and good luck in your career. J
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My site may contain affiliate links. Meaning, I get a commission if you purchase through my links, at no cost to you. However, I do not recommend lightly – if I like it I want you to know about it. J
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Article • 5 min read
Gibbs' Reflective Cycle
Helping people learn from experience.
By the Mind Tools Content Team
Many people find that they learn best from experience.
However, if they don't reflect on their experience, and if they don't consciously think about how they could do better next time, it's hard for them to learn anything at all.
This is where Gibbs' Reflective Cycle is useful. You can use it to help your people make sense of situations at work, so that they can understand what they did well and what they could do better in the future.
What Is Gibbs' Reflective Cycle?
Professor Graham Gibbs published his Reflective Cycle in his 1988 book " Learning by Doing ." It's particularly useful for helping people learn from situations that they experience regularly, especially when these don't go well.
Gibbs' cycle is shown below.
Figure 1 – Gibbs' Reflective Cycle
From "Learning by Doing" by Graham Gibbs. Published by Oxford Polytechnic, 1988.
Gibbs' original model had six stages. The stage we haven't covered here is "Analysis" – we've included this as part of the Evaluation stage.
Using the Model
You can use the model to explore a situation yourself, or you can use it with someone you're coaching – we look at coaching use in this article, but you can apply the same approach when you're on your own.
To structure a coaching session using Gibbs' Cycle, choose a situation to analyze and then work through the steps below.
Step 1: Description
First, ask the person you're coaching to describe the situation in detail. At this stage, you simply want to know what happened – you'll draw conclusions later.
Consider asking questions like these to help them describe the situation:
- When and where did this happen?
- Why were you there?
- Who else was there?
- What happened?
- What did you do?
- What did other people do?
- What was the result of this situation?
Step 2: Feelings
Next, encourage them to talk about what they thought and felt during the experience. At this stage, avoid commenting on their emotions.
Use questions like these to guide the discussion:
- What did you feel before this situation took place?
- What did you feel while this situation took place?
- What do you think other people felt during this situation?
- What did you feel after the situation?
- What do you think about the situation now?
- What do you think other people feel about the situation now?
It might be difficult for some people to talk honestly about their feelings. Use Empathic Listening at this stage to connect with them emotionally, and to try to see things from their point of view.
You can use the Perceptual Positions technique to help this person see the situation from other people's perspectives.
Step 3: Evaluation
Now you need to encourage the person you're coaching to look objectively at what approaches worked, and which ones didn't.
- What was positive about this situation?
- What was negative?
- What went well?
- What didn't go so well?
- What did you and other people do to contribute to the situation (either positively or negatively)?
If appropriate, use a technique such as the 5 Whys to help your team member uncover the root cause of the issue.
Step 4: Conclusions
Once you've evaluated the situation, you can help your team member draw conclusions about what happened.
Encourage them to think about the situation again, using the information that you've collected so far. Then ask questions like these:
- How could this have been a more positive experience for everyone involved?
- If you were faced with the same situation again, what would you do differently?
- What skills do you need to develop, so that you can handle this type of situation better?
Step 5: Action
You should now have some possible actions that your team member can take to deal with similar situations more effectively in the future.
In this last stage, you need to come up with a plan so that they can make these changes.
Once you've identified the areas they'll work on, get them to commit to taking action, and agree a date on which you will both review progress.
Frequently Asked Questions About Gibbs' Reflective Cycle
What is purpose of Gibbs' Reflective Cycle?
The reflective cycle is a way to better learn from experience. It can be used to help people learn from mistakes, to make sense of situations, and analyse and refelct on their reactions to different situations.
What are the six stages of reflection?
The stages of Gibbs' Reflective Cycle are the following: descrition, feelings, evaluation, conclusion, and action. In the original model Gibbs included a sixth stage, analysis, which we've included in the evaluation stage.
What is the difference between Gibbs and Kolb's reflective cycles?
David Kolb's cycle has only four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. Kolb's model is more about explaining the concept of what he calls "experiential learning" – whereas Gibbs' cycle is an attempt to provide a practical method for learning from experience.
This tool is structured as a cycle, reflecting an ongoing coaching relationship. Whether you use it this way depends on the situation and your relationship with the person being coached.
Graham Gibbs published his Reflective Cycle in 1988. There are five stages in the cycle:
You can use it to help team members think about how they deal with situations, so that they can understand what they did wel and where they need to improve.
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- v.9(2); 2023 Feb
Master of nursing specialist experiences of an internship through the use of written reflections: A qualitative research study
a Department of Brain Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, No. 117 Meishan Street, Hefei, 230031, Anhui, China
b School of Nursing, Anhui University of Chinese Medicine, No. 103 Meishan Street, Hefei, 230031, Anhui, China
Data included in article/supp. material/referenced in article.
Reflective practice is an educational strategy and an essential part of the professional development of nurses. However, there are few reflective journals in the master of nursing specialist program or clinical nursing education.
Based on Gibbs' reflective cycle theory, masters of nursing specialists (MNS) will use a diary to record their reflections on a particular clinical event. The purpose of this study was to identify reflective practice as tool to help MNS improve their professional and personal development.
A descriptive qualitative study.
The purposive sampling method was used in the qualitative study. The data were derived from the master of nursing specialist who interned at the hospital from June to December 2021. After completing the job rotation and relevant course training within 6 months, a clinical experience was selected as a reflection. The traditional qualitative content analysis method was applied to analyze the collected data in the research.
A total of 10 reflective diaries completed by ten students were analyzed. This qualitative study demonstrated that the Gibbs' reflective cycle is valuable and helpful in the clinical practice of master of nursing specialists. This program helps master of nursing specialists reflect on their clinical practice and translate real-life experiences into valuable learning experiences for developing their professional development and personal skills.
By writing reflection diaries, master of nursing specialists can reflect on the problems encountered during clinical rotations and take action following that reflection, which can assist them in improving their professional development and personal skills to handle clinical nursing aspects in the future, as well as improve their full participation in clinical practice.
Reflective practice is not only an educational strategy [ 1 ] but also a core skill for the professional development of nursing students [ 2 ]. Research has shown [ 1 ] that reflection provides caregivers with the ability to learn from clinical experiences through critical thinking. This helps stimulate learning and add new knowledge to clinical practice, facilitating practice transformation and the development of new insights [ 1 ]. The study also found that it can use scientific knowledge, personal knowledge, and experiential knowledge to solve complicated problems in practice [ 3 ]. Moreover, studies have shown that reflective practice, as a cognitive skill that nurses learn from experience, can improve the knowledge and skills of nursing students, novice nurses, and experienced nurses in clinical practice, improve the professional practice of nurses and positively improve the health outcomes of patients [ 1 , 4 ]. It has also been reported that reflective practice can enhance a clinician’s competence through a critical review of clinical practice [ 5 ]. Additionally, an integrative review has demonstrated that nursing professions at all levels are influenced by reflective practices, adding value to the nursing profession [ 6 ].
As a member of the nursing workforce, a master of nursing specialist (MNS) is expected to have higher levels of professional competence, practical competence, critical and reflective ability, and interpersonal communication when faced with complex clinical environments [ 7 , 8 ]. In direct contact with patients in clinical practice, MNS may encounter unexpected clinical situations leading to stress [ 9 ], and most of these clinical experiences have not been effectively addressed. Therefore, reflective practice is necessary for MNS for patient safety [ 4 ] nurses' own physical and mental health, and coping with future challenges [ 4 ]. Reflective practice improves nurses' understanding of their practice by giving meaning to their experiences [ 4 , 10 ], thereby enhancing their personal and nursing professional development [ 2 ], and narrowing the gap between theory and clinical practice in nursing humanistic care dimension [ 10 ]. The reflective journal is the most commonly used tool in reflective practice [ 9 ], and it is seen as a learning tool in postgraduate medical education [ 11 ]. Studies have shown that the process of writing a reflective journal, through the practice of self-reflection and reflective writing, can help release clinically repressed emotions [ 6 , 9 ]. As a reflection tool, a diary is considered to reflect on oneself and others [ 12 ] during critical clinical events, which can facilitate the learning process, personal growth, and professional development of nursing students [ 13 ] through an in-depth understanding of what clinical experience means [ 12 , 14 ]. It is recommended that participants consider their feelings during the six stages of Gibbs’s framework, such as reflection, description, feeling, evaluation, analysis, conclusion, and action plan [ 2 , 15 ]. The Gibbs’s reflective cycle provides a structured approach that has been successfully applied to nursing majors and nursing students, enabling students to logically reflect on clinical events [ 16 , 17 ]. Structured templates, however, may compromise the quality and authenticity of the data collected. Nevertheless, Gibbs' reflective cycle was found to be an effective, useful, and enjoyable method for teaching clinical education [ 18 , 19 ]. The Gibbs’s reflective cycle [ 19 ] also showed that most people’s knowledge and understanding are obtained from a reflection of the experience, and constantly thinking can lead to a better understanding of things, and the guidance of action.
Based on Gibbs’s reflective cycle, reflective practice has been successfully performed in some countries, such as Japan’s public health graduate and undergraduate students [ 19 , 20 ] and nursing staff in China [ 21 ]. The study found that MNS in China must have the ability to enhance personal reflection and professional ability [ 7 , 8 ], and Gibb’s reflective cycle can be used as a theoretical framework for beginning writers to reflect on their behavior, to improve their performance [ 16 , 17 ]. According to researchers [ 21 ] in China, using Gibbs’s reflective cycle can improve nurses' ability to engage in clinical nursing thinking when dealing with adverse events, especially by helping nurse practitioners who work for 0.5–1 year gain a more comprehensive understanding of adverse events.
However, the theoretical framework of the Gibbs’s reflective cycle has not been applied to the analysis of MNS’ clinical experience. And it is not clear whether reflective practice can improve the professional ability and personal development of MNS. Hence, understanding the clinical experience is essential for the personal and professional development of MNS. Reflections on the clinical experience of MNS were explored in the context of clinical practice in this study.
2.1. Type of research design
A descriptive qualitative study was applied to the study.
2.2. Settings and populations
The purposive sampling method was used in qualitative research because it can improve the transferability of research [ 22 ]. The study subjects were all MNS interning at the hospital. The first author has overseas study experience and participated in Gibbs' Framework training abroad. All four researchers participated in a qualitative research course. Participants interested in the program were invited in person by the program leader at the MNS Academic Salon meeting. Participants then signed written informed consent at the site, and the program leader distributed Gibbs’s reflective cycle course schedule along with a verbal statement asking participants to provide at least one written reflection material via WeChat or email at the end of the program. Out of 13 eligible participants, ten eventually agreed to participate and completed and submitted reflective writing.
The respondents included nine females and one male. To protect participants' privacy, all participants' information is encrypted from P1 through P10. Participants are only required to provide their ages and work experience. The students are between 24 and 30 and have completed 10–12 months of clinical practice at the undergraduate level of nursing education before their postgraduate education. According to China’s internship regulations, all of them have full internship experience including but not limited to the internal medicine department, surgical department, ICU, and operating room. Moreover, none of them had prior nursing-related work experience before becoming MNS, only undergraduate internships. In addition, MNS has a clinical internship of at least six months and is required to take classes related to Gibbs’s reflective cycle. During the six-month internship, they were mainly involved in the care of patients with chronic diseases such as Wilson’s disease and Parkinson’s disease, including intravenous injection and the implementation of traditional Chinese medicine nursing techniques.
2.3. Data sources
The reflective diary based on Gibbs’s framework is used as the original material for this study. In diary writing, the study adopted the structure of Gibbs’s reflective cycle, which consists of six modules: reflection, description, feeling, evaluation, analysis, conclusion, and action plan [ 2 , 15 ]. This model was chosen because of the successful application of the Gibbs Reflection Cycle to reflection in the nursing profession [ 16 ], which not only allowed participants to write a reflection diary step by step but also allowed them to take into account their feelings about clinical events [ 2 ,  ,  ,  ].
The concept and steps of the Gibbs reflective cycle, application cases in the clinical field of nursing, and writing principles were explained by the project leader. There are eight classes, each lasting about 20 min. The research team leader at any stage of the study didn’t affect the MNS internship phase of the score, also won’t for internship experience in an oral or written judgment. Gibbs’s reflective course is taught face-to-face in the classroom. Gibbs' reflective practice courses and reflective writing are guided by nursing professionals or program leaders with at least ten years of experience. After six months of clinical practice, participants were asked to describe their feelings about clinical events based on the Gibbs reflection cycle model. In addition, students were required to complete and submit at least one clinical experience diary about their reflective learning experience.
2.4. Data analysis
Qualitative research data was conducted from ten independent texts with a total of 11, 899 Chinese characters. The writing template of all manuscripts was A4 paper size, the Chinese font was required to be Song style, the size of the font was 4, and the line spacing was 1.5 times. Traditional content analysis, which aims to describe a phenomenon, is often used in qualitative research designs [ 23 ]. All the researchers through qualitative research training, study the authenticity of the data, data collecting, sorting, and analysis by different researchers. Initially, the texts were entered into NVivo 12 software, by the researchers (second author) on the material number and document, personally involved in the data sorting, repeated readings, and immersed in the data, to have an integral feeling of the information. Then, data are analyzed and coded based on Gibbs’s framework, and categories and topics are extracted by two researchers (second and third authors), respectively. At the same time, the two researchers have professional accomplishments and social relations, making it can grasp the role and status of the research team, to enhance the reliability of the author. In this process, the researchers will be meaningful words, phrases, sentences, or passages marked, and begin to open coding. Subsequently, the categories and subcategories were discussed and evaluated by the members of all the studies, and the final themes were identified. After this stage, to encode the original material, the researchers carried out the coding system will be the same or similar coding classification form a category or categories. The study design is designed under the framework of the Gibbs’s reflective cycle, so will be the same or similar code, again classified to the Gibbs’s framework. When data after the complete category, the researchers again take out each category file, read all the excerpts, and ensure that materials and categories, can find corresponding extracted from the data sample. Encoding steps above all by two different researchers (second and third authors) for the first time after coding, and face-to-face to check coding categories, after carefully discussion decided to subject classification. If any disagreement, after discussing with the fourth author and project director. Additionally, to guarantee data integrity and authenticity, a compiled manuscript subject was returned to participants for comment and/or correction. The whole data analysis process was conducted in Chinese and finally translated into English. The consolidated criteria for reporting qualitative research (COREQ) were followed by this study [ 24 ].
2.5. Establishment of trustworthiness
Studies have reported [ 22 , 25 ] that researchers can use Lincoln and Cuba’s criteria, including credibility, reliability, confirmability, and transferability, to ensure the trustworthiness of qualitative research. First, credibility refers to confidence in the authenticity of the information from the participant’s point of view [ 25 ]. In this study, all nursing graduate students participating in the study had at least ten months of nursing clinical practice experience during their undergraduate years, as well as at least six months of clinical practice experience in different departments for MNS postgraduates, to ensure that participants had authentic experience and opinions about the clinical practice experience, thus ensuring the credibility of the study. Second, reliability refers to data stability in different places at different times [ 25 , 26 ]. The study ensures the reliability of the data collection process by carefully describing the investigator’s recruitment and reflective practice courses so that readers can see the content of the entire research process. Third, conformability refers to the objectivity or neutrality of the data and refers to the agreement of independent people on the relationship or significance of the data [ 25 ]. The Gibbs reflective cycle framework is applied to the reflective process and is used for data analysis, making the writing structure visible. In addition, the two authors (the second and fourth authors) analyzed and encoded the text data independently. If there is any disagreement during the analysis, discuss it with the third author (first author) and resolve it through negotiation. Fourth, transferability refers to the significance of the research results for other groups in similar situations, also known as suitability, meaning the extensibility of the data [ 25 ]. Gibbs’s theory is applied to this qualitative research, and if it is based on the same approach, it can be applied to similar research.
2.6. Ethical issues
This study was approved by the ethics committee of the First Affiliated Hospital of Anhui University of Chinese Medicine. The Declaration of Helsinki [ 27 ] was used to follow the ethical guidelines for this study, which mainly analyzed the empirical reflection of MNS in clinical practice and had no impact on patient care. All data were anonymously encoded and then analyzed to ensure the participants' privacy. Participants received detailed oral and written information about the research presented by the researchers (first and second authors) during the course. All willing students were asked to sign an informed consent form after the researchers introduced the purpose of the study and how the data were collected. Although all participants were required to sign a written informed consent form, they were also informed that anyone was free to withdraw from the study at any time.
Based on Gibbs’s framework, the topic categories of this study are proposed. This paper summarizes the reflections on the clinical practice experience of MNS, as shown in Table 1 .
3.1. Descriptions of the clinical practice experience
The traditional qualitative content analysis of reflective journals indicated that MNS most frequently described the clinical practice experience as the three themes of adverse events, professional knowledge, and nurse-patient conflict. First, the adverse events were described by the MNS as the use of the wrong medication when the patient received the treatment and the scalding of the patient due to the failure to assess the patient’s skin condition in time or unclear account. Second, participants described their lack of professional expertise in clinical practice, including insufficient theoretical preparation and unskilled operation skills, and the lack of professional knowledge caused inevitable pain to patients or made them feel embarrassed when facing patients. Third, nurse-patient conflict was described as patient bias towards MNS clinical practice and a lack of communication and feedback between nurse-patient.
Negative emotions associated with the clinical practice were anxiety, guilt, worry, and nervousness. For example, when nursing graduate students were involved in the care of patients with scalds that were not immediately detected and treated by nursing staff, participants often experienced feelings of anxiety and guilt. Worry and nervousness usually arise when MNS care for patients with a lack of professional skills, resulting in patients being exposed to certain risks. Such as, participants described feeling guilty about giving patients the wrong medication or the wrong infusion, as well as feeling nervous and worried about patient safety.
Conversely, in clinical practice, positive emotions of happiness are also mentioned. The participants described their feelings after answering the patients' nursing knowledge of a particular specialty. For example, when the participants were trusted by the patients and successfully solved the patients' questions by seeking relevant literature, they were generally recognized by the patients, thus feeling the value of the internship and having a happy mood. These unique experiences motivate the participants.
P4: “Although I don't care much about what other people think, I am happy to be acknowledged by patients. I also felt self-worth as a nursing graduate student, although people always have a skeptical attitude towards nursing graduate students. ”
Moreover, the safety of the patients and understanding of the situation was often described by participants when referring to thoughts during and after this situation. In this situation, participants usually remain calm, such as quickly ending the unfair treatment or infusion of the patient, and removing some potential risk factors that may endanger the patient’s safety. In addition, participants will try to understand and find the cause of the event and then evaluate the harm their behavior has caused the patient.
P10: “ I could not bear the consequences if other special drugs were changed by mistake. ”
P9: “But the scalding incident proved me wrong and I felt very guilty for causing such a young child to suffer.”
The evaluation consists mainly of two aspects: what was a good experience and what was a bad experience. In clinical practice, good experience primarily referred to the response of nursing graduate students to conflict. Participants reported that they were able to quickly disengage from a conflict situation and remain calm when confronted with a conflict, which impressed them when they administered an infusion or hot compress of Traditional Chinese medicine. This similar experience enabled participants to learn how to deal with these situations encountered in clinical practice, such as help from clinical teachers and seeking forgiveness from patients and families.
P2: “The patient’s infusion sequence was disrupted. The conversation with the patient went well, and she finally showed understanding. I also explained this matter to the superior teacher later.”
The bad experiences were associated with concerns about the situation. When participants participate in patient care in ineffective or unprofessional ways, this interaction often leads to some distress for the patient. For example, nursing graduate students lack the skills to perform infusion operations, leading to the behavior of secondary puncture, even if the patient understands, but also increases the patient’s physical pain. Patients also often suffer the negative consequences of medication errors, burns, and other physical and mental injuries.
What was done well and what was done wrong were described by participants in clinical practice. Seeking help from clinical teachers and being empathetic to patients were described by participants as doing well in clinical practice. For instance, when the participants found that the patients had burns, they immediately sought the help of clinical teachers to relieve the patient’s pain. In addition, personal unprofessional behavior not only increased the cost of patient treatment but also caused patients to bear different degrees of physical and mental pain. The participants were able to be patient-centered, understand the patient’s feelings of dissatisfaction, and empathize with the patient’s experience.
P1: “ The pain caused by the swelling of the arm caused by the improper operation is unbearable to the patient. The patients and their families are not satisfied with me, but I can understand the discomfort caused by the patient ’ s pain and sincerely apologize to the patients and their families. ”
P9, P6, P8: “Even though the patient understands my unprofessional nursing practices, I still feel empathy for the patient, and I feel guilty.”
In clinical nursing, the lack of professional skills (theoretical or operational skills) and the lack of information communication and feedback between nurses and patients, nursing postgraduates, and clinical teachers lead to some undesirable phenomena. Such as, participants reported that a lack of professional skills or poor communication led to scalds or nurse-patient conflicts. Furthermore, it has also been reported that ignoring a patient’s emotions can lead to dissatisfaction with the caregiver, even if the individual’s behavior does not negatively affect the patient’s health.
P3: “I felt deeply guilty and uneasy about my actions. At that time, I found that I did not change the wrong liquid, ignoring the patient’s psychological feelings, and deliberately playing down this matter. As a result, the patient complained.”
Based on Gibbs’s reflective cycle, the good clinical practice includes good communication skills and respect, solid medical knowledge, and clinical teacher support. Good communication skills were considered to be one of MNS the necessary skills [ 28 ]. Especially for nursing graduate students with bias, timely and effective transfer of professional nursing knowledge and the situation that may arise from it, to maintain a good nurse-patient relationship. The study suggested that respect is mutual [ 29 ], the respect and understanding shown by participants towards patients increase the patients' respect towards them. Moreover, solid medical knowledge for MNS of clinical practice was mentioned, as a good clinical practice requires both theoretical and operational expertise, solid medical knowledge can answer the questions of patients and how to complete the operation accurately. It also mentioned the problem of treating patients' intellectual blind spots or emotional distress seriously, not ignoring them, but responding to the literature carefully or paying attention to the patient’s emotions in time. In addition, participants sought help from clinical instructors [ 30 ] to reduce unnecessary problems when their behavior might lead to changes in a patient’s condition or verbal conflict.
P1: “With the accumulation of clinical practice, I realized my shortcomings at that time. I should pay more attention to the patient’s expression and body language, carefully evaluate the patient’s clinical indicators and performance, and learn more skills from teachers should not be blind operation to prevent some of the side effects of scraping. When there are side effects, I should also ask my supervisor to evaluate the situation and do what I can.”
Besides, conclusions about participants' abilities were based on their evaluations of their behavior during and after clinical practice. Participants said they were aware of their professional responsibilities and the severe consequences of their deficiencies, such as the need to improve their attitudes and improve skills in assessing patients in clinical practice [ 30 ]. Through this reflection, the researchers also believe that their lack of crisis awareness [ 31 ], and failure to do an excellent job in nursing which is due to their usual learning and working attitude caused.
In addition, participants' needs for knowledge were related to medication safety, patients' psychological status, and respect for and empathy with patients. Some graduate nursing students who have just participated in clinical nursing practice lack basic knowledge of self-discipline, respect and compassion, medication safety [ 32 ], and clinical work procedures. Therefore, the need for this knowledge was considered valuable and necessary in clinical practice.
3.6. Action plan
It is clear from Gibbs' analysis of reflective data that MNS is sometimes satisfied with their behavior because their performance is professional, and they can gain experience from clinical practice. Respecting and empathizing with the physical and mental suffering of patients, providing timely feedback and effective treatment, paying attention to drug safety [ 32 ], and listening to and understanding the needs of patients were mentioned as being professional behavior.
P7: “I should stop this from happening at the source, communicate with the patient and give feedback to the higher level, provide adequate treatment to the patient, and make sure we have the support and understanding of the patient and the family. At the same time, I should also learn more to strengthen their professional skills. ”
Recommendations for improving action include timely feedback and communication, being patient-oriented, strengthening clinical skills, and following the nursing code of conduct. One suggestion for timely feedback and communication is to maintain effective communication with patients and supervisors when conflicts or adverse events occur and to provide timely feedback on outcomes [ 28 ]. Communication and feedback should also be patient-oriented when the patient’s physical and mental integrity is compromised. Researchers believe that [ 33 ] MNS should have prospective thinking in clinical practice, which is to evaluate the patient’s physical and psychological status comprehensively, observe more during treatment, and reduce the risk of adverse events. Participants also mentioned that when problems are encountered in future clinical practice, they should be more proactive in paying attention to the specific needs of patients and consulting experienced clinical teachers [ 30 ].
This study aims to promote the learning, personal, and professional development of MNS by reflecting on clinical experiences based on the Gibbs’s framework. Reflective writing by MNS was applied to this study. The study indicated that MNS most frequently described the clinical practice experience as the themes of adverse events, professional knowledge, and nurse-patient conflict. MNS was expected to be the leaders or managers of the nursing profession [ 33 ]. Still, the gap between school education and clinical practice [ 33 ] may lead to the problem of insufficient professional knowledge and communication ability of MNS in clinical practice, at the same time, MNS were not Down to Earth in clinical work, which can lead to adverse events.
MNS had complex emotions in clinical practice, including negative feelings, such as anxiety, worry, tension, guilt, and positive emotions of happiness. Despite the emotional challenges of communicating with patients in clinical practice, the majority of MNS said they understood the feelings in clinical practice and were concerned about patient safety. The study help to understand the feelings and thoughts of MNS as they emerge from complex clinical experiences during clinical work. This is consistent with the results of another study from Taiwan in China, which reported that participants reflected on events with both positive and negative thoughts [ 34 ].
Participants also felt that reflective writing helped them to learn from their experiences and promote professional development [ 2 , 34 ]. Such as being able to remain calm and quickly deal with incidents during conflicts in clinical practice while seeking help from clinical faculty [ 30 ], and seeking understanding and empathy from patients and families. In addition, participants described concerns about the adverse consequences of MNS in the clinical setting due to ineffective and unprofessional communication with patients. This is in line with the concept of “patient-centered improvement of medical service quality” proposed by the National Health Supervision Commission of the People’s Republic of China and reflects the professional concept of nursing staff to take the safety and interests of patients as the criterion at all times.
Although the clinical practice settings described by participants varied, possibly due to the study’s use of Gibbs’s reflective cycle, the study found that reflection was seen as beneficial for participants' feelings, thoughts, and actions [  ,  ,  ]. Participants felt it was meant to reflect on events in clinical practice to help them do things the next time they faced a similar situation [ 20 ]. Generally, for MNS, it is not only necessary to master solid clinical expertise but also to learn the ability to communicate and feedback information [ 33 ] so that learn to reduce the impact of adverse events on personal emotions and to think about clinical events more positive and mature way [ 34 ]. The findings of this study suggest that increased reflective writing is necessary for future clinical education in MNS. As in previous studies [ 1 , 2 ], participants in this study were able to gain experience from the clinical experience and provide advice for future action. In summary, reflective learning is not only a valuable learning strategy for MNS in clinical practice but is also seen as a helpful tool for MNS learning, personal ability, and professional development.
This study has some limitations. First, the sample size was small and came from MNS interning at the same hospital, and it is unknown whether the study results apply to different clinical Settings in different countries. In addition, the study did not include the reflection of other clinical populations, such as how clinical teachers and MNS mentors evaluated the content of MNS reflection and whether it promoted the development of the clinical profession. Moreover, the rationality and effectiveness of the reflection practice curriculum design need to be further discussed.
This qualitative study presents an analysis of the self-reflective relevance of MNS in clinical practice. MNS needs to deal with complicated and unexpected clinical events in clinical practice. To deal with and cope with these situations on time, MNS needs to have good nursing professional skills, such as theoretical and operational skills, and a good mentality to understand and care for patients [ 33 ]. In this qualitative study, it was demonstrated that the Gibbs’s reflective cycle is helpful in the clinical practice of MNS. It helps MNS reflect on clinical practice and translates clinical experience into a valuable experience for developing personal and professional development.
Author contribution statement
Ting-ting Zhan: Conceived and designed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Li-li Wang: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.
Yan Wang; Cai-jie Sun: Analyzed and interpreted the data.
Ting-ting Zhan was supported by Provincial Quality Engineering Project for Higher Education Institutions of Anhui Province in China [2020JYXN1053].
Data availability statement
Declaration of interest’s statement.
The authors declare no conflict of interest.
The authors would like to appreciate the support from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, China and all the researchers and participants involved in this study for their support.
Reducing violence and aggression in the emergency department
- 1 NHS Lothian District Nursing Services. [email protected]
- PMID: 23901870
- DOI: 10.7748/en2013.07.21.4.26.e687
Emergency department (ED) staff, particularly nursing students and inexperienced nurses, are at risk of violence and aggression from patients. However, by reflecting on violent incidents, nurses can gain new knowledge, improve their practice and prepare themselves for similar incidents. This article refers to the Gibbs reflective cycle to analyse a violent incident involving a patient with mental health and alcohol-dependence problems that occurred in the author's ED. It also identifies strategies for nurses to pre-empt and defuse violent situations.
- Aggression / psychology*
- Emergency Service, Hospital*
- Mental Disorders / nursing
- Nurse-Patient Relations*
- Substance-Related Disorders / nursing
- Violence / psychology*
Communication in Nursing Practice: Gibbs’ Reflective Cycle Essay
Introduction, description, action plan, reflective conclusion.
Communication is a fundamental element in nursing practice. This element can possibly determine patients’ satisfaction and even the outcomes of their treatment (2). The situation described in the paper will exemplify the potential role of communication. Gibbs’ Reflective Cycle will help to assess the situation and extract lessons from it. The model is a widely-recognized and crucial learning instrument, allowing individuals to extract lessons from life experiences. The pattern helps one to consider previous experiences, reevaluate them in the light of new knowledge, and implement the freshly obtained insight to improve future practice (1). The cycle is composed of six stages (description, feelings, evaluation, analysis, conclusion, and action plan), on which the reflection regarding the personal experience will be based (1). The paper’s principal objective is to outline a challenging situation from personal practice using Gibbs’ Reflective Cycle. The problematic situation is an encounter with a patient suffering from an infected diabetic foot ulcer and in need of amputation. Overall, the paper aims to critically analyze the situation and transform it into a learning opportunity useful in improving my future practice as a wound care specialist.
The situation concerns a 40-year-old patient with diabetes and an infected foot ulcer who was admitted to the hospital where I was working at the moment. The patient had a long history of diabetes from which he suffered since he was 10 years old. A multidisciplinary team examined the patient and established that he needed an amputation. As I approached the patient to get a consent form, I noticed that he looked upset. Given the described situation, it might be suggested that a communication dilemma here is of ethical character, in particular – it is the delivery of the bad news. By applying Gibbs’ Reflective Cycle, the discussion below will demonstrate what actions were undertaken to resolve the mentioned dilemma.
The incident that will be analyzed happened several years ago when I began working as a wound care nurse. A 40 years old diabetic patient with an infected diabetic foot ulcer was admitted to the hospital. He had a long history of diabetes, suffering from the condition for three decades. A multidisciplinary team examined and communicated with the patient; it was established that he needed a below-knee amputation. The group stated their decision and left, and I had to retrieve the consent form. While retrieving the record, I perceived that the patient looked exceedingly sorrowful and depressed. Nevertheless, I did not know whether I needed to intervene in the situation and left.
Although I worked for many years in nursing before the incident, I became a certified wound care nurse relatively recently before it succeeded. At the moment, I saw the situation as irreparable, so I was not sure whether I should have tried to console the patient. I felt anxious and, to an extent, powerless when faced with the man’s grief. I thought that words or an empathic response would not be able to mitigate his sadness. Additionally, I was also somewhat startled that the multidisciplinary team did not handle the conversation more delicately and left rather abruptly. Overall, I did not feel confident enough to handle the situation and was unsure whether my intervention would be appropriate.
I frequently returned to the incident in my thoughts, trying to understand what should have been done instead. Retrospectively, I believe that it helped me to reevaluate the role of therapeutic communication in my profession. Prior to the incident, I did not perceive preoccupation with patients’ emotional well-being as my duty as a nurse. I believed that administering medications and treatment, performing tests, recording medical history, educating patients, et cetera was all that was required of me. Nevertheless, in the described situation, I did not fulfill another vital function. To understand that a holistic approach to care presupposes therapeutic communication, I had to experience the case (2). As a nurse, showing empathy and consoling patients is also a critical function that sometimes is overlooked. Furthermore, the incident demonstrates a lack of cooperation between the nursing staff and the team since communication was needed to ensure that the emotional impact of amputation on the patient was alleviated.
Some medical professionals find the process of delivering bad news challenging and feel psychologically unprepared (3). A lack of skills in this aspect can negatively affect patients: they might undergo extra stress, have lower psychological adjustment, and have worse health outcomes (4,5). Furthermore, the way the news is handled can impact patients’ understanding of the situation and adherence to treatment (6). Given the adverse effects, multiple protocols, approaches to communicating bad news, and dealing with its consequences were developed. In the patient- and family-centered approach, the process occurs based on the patient’s needs as well as their cultural and religious beliefs (7). Upon communicating the information, a medical professional is supposed to assess their understanding and show empathy (7). In an emotion-centered approach, a medical professional is supposed to embrace the sadness of the situation and build the patient-medical professional interaction on empathy and sympathy (7). Yet, the patient- and family-centered approach seems more effective since excessive empathy can be counter-productive and impede information exchange.
Managing patients’ reactions is the final and particularly vital step of communicating bad news. Nurses are commonly involved in handling emotional responses, which entails several responsibilities:
- Additional emotional support should be given to those who cannot accept the information (8).
- Nurses can find more related information and share it with patients (8).
- Nurses are supposed to improve the situation if bad news has been delivered poorly (8).
In the case of amputation, heightened emotional attention should be given to the patient, as limb loss is a life-altering procedure. Such patients commonly undergo the six stages of grief (denial, anger, bargaining, depression, and acceptance) and are prone to developing anxiety, depression, and body image issues (9). Hence, upon delivering the news regarding amputation, it is vital to provide a patient with community resources for dealing with emotional and psychological implications.
Currently, I understand more in-depth that delivering and handling the consequences of bad news is an inescapable reality of the nursing profession. The incident allowed me to notice the aspects of my professional development that necessitate more attention and improvement. Hence, I strive to be more empathetic in my clinical practice and not undervalue the role of patient-nurse communication. I attempt to provide psychological and emotional support to patients and console them to the best of my ability and knowledge, especially if a patient has just received traumatic news. Due to the incident, I comprehended better that a patient’s emotional well-being can be dependent on my actions. I also stopped presuming that other medical professionals provide the necessary emotional support. Moreover, I understand that I am not powerless when faced with a patient’s sorrow.
Consequently, I will not neglect the importance of patient-nurse communication for patients’ health outcomes and mental well-being. I will offer hope where it is appropriate, encourage, and validate patients’ emotions to help them deal with traumatic information (10). In the future, I will use verbal and non-verbal communication clues to show that I care and, generally, be more empathetic (11). I will not prevent my insecurities from fulfilling my nursing duties, nor will I allow the feeling of hopelessness to affect my clinical practice. Furthermore, I will rely on evidence-based approaches to handle bad news effectively and facilitate its delivery to patients.
Additionally, I will be more mindful in my nursing practice. Gibb’s reflective cycle will assist me in attaining this objective. I will continue to apply it to the situations occurring at work in order to think systematically as well as analyze and evaluate them. Furthermore, Gibb’s reflective cycle will enhance my ability to learn from my experience. The model will help me to refine my communication skills and make patient-nurse interactions more intuitive and productive (1).
The situation allowed me to understand the actual value of therapeutic communication in nursing and the need to exercise it in my clinical practice. Learning to provide emotional support and manage the consequences of bad news is an essential quality for nurses, influencing health outcomes and satisfaction from a visit. Additionally, I become more conscious of my own emotions and the way they can prevent me from acting in a patient’s best interests. Overall, the proper tactics of delivering bad news and assisting patients in handling them became a higher priority in my clinical practice.
To conclude, this reflection featured an episode from my practice in which I analyzed a communication situation using Gibbs’ Reflective Cycle. It showed that I need to concentrate on my abilities to resolve the communication dilemma of the delivery of bad news. The above discussion also demonstrated how the implementation of an appropriate and significant evidence-based model – Gibbs’ Reflective Cycle – may result in better patient outcomes.
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- Gibbs’ Reflective Cycle
- Learning Theories of Kolb, Schön, and Gibbs
- Nursing Practicum Based on Gibbs’ Framework
- Gibbs’s Reflective Cycle and Borton’s Model of Reflection
- "The Epic of Gilgamesh" by Ryan Gibbs
- The Topic of Diagnostic Measures
- Ethos, Pathos and Logos in "The Exploitation" by Adam Rulli-Gibbs
- Medical Ethics of Amputation
- Crime Punishment: Shame Is Worth a Try
- “What is the Definition of Terrorism? And why is the White House Afraid of Using the Term?” by Timothy Kelly
- Modern Nurse’s Role: Leadership
- Professional Mentoring in the Context of the Dnp
- Nurse Leader and Abbott Northwestern Hospital
- Mindfulness Meditation Program and Nursing Outcomes
- Issue of Nursing Turnover
International Conference on Professional Culture of the Specialist of the Future
PCSF 2022: Technologies in a Multilingual Environment pp 324–337 Cite as
Psychological Risks of a Successful Pupil
- Sofya Tarasova ORCID: orcid.org/0000-0002-5621-2999 11
- Conference paper
- First Online: 19 February 2023
Part of the Lecture Notes in Networks and Systems book series (LNNS,volume 636)
This study examines risk factors of a successful pupil’s psychological health. Introduction of new technologies and multilingualism in educational technologies influence emotional life of an adolescent. The purpose is to discover correlations between trait anxiety and aggressiveness among adolescents in prestige educational institutions. The study explains the differentiation between adaptive and maladaptive perfectionism. The overall excellent performance of a pupil may hide risks of adaptation disruption. The analysis of psychological profiles of adolescents from risk group for maladaptive perfectionism was performed using qualitative and quantitative research methods. The total of two hundred pupils of the 8 th grade from three prestige schools took part in the research. According to the research, the markers of maladaptive behavior of a successful pupil are trait anxiety, maladaptive perfectionism, hostility, and anger. About 20% of the participants fall into the risk group for anxiety. Objectively, their performance is high, but teenagers have doubts about their success, demonstrate tendency for delaying, the inability to start doing something. In this case the anxiety is caused by fear of not conforming to self-imposed high standards. Self-esteem anxiety is related to the components of Self-Image: intelligence, situation at school, communication, self-confidence. Non-conformity to self-imposed standards and procrastination are related to anger. As qualitative research methods showed psychological risks may reach the level of destructive personality tendencies. Anxiety markers of a successful pupil, including psychosomatic manifestations were described. They can be useful for teachers. Prevention work in schools has to be complex and interdisciplinary. It is a teacher-psychologist tandem that is needed.
- Destructive personality tendencies
- Risk factors
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Correspondence to Sofya Tarasova .
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Department of Social Sciences, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
Institute of Philosophy, Technical University of Darmstadt, Darmstadt, Hessen, Germany
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Tarasova, S. (2023). Psychological Risks of a Successful Pupil. In: Bylieva, D., Nordmann, A. (eds) Technologies in a Multilingual Environment. PCSF 2022. Lecture Notes in Networks and Systems, vol 636. Springer, Cham. https://doi.org/10.1007/978-3-031-26783-3_27
DOI : https://doi.org/10.1007/978-3-031-26783-3_27
Published : 19 February 2023
Publisher Name : Springer, Cham
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