This is one of a series of articles relating to reflective practice.
In this article, we are going to be taking an in-depth look at a model of reflection created by Christopher Johns- a professor of nursing- in 1994. We will be examining the model thoroughly, including the advantages and disadvantages of the model, as well as some general knowledge about its creator.
Let’s get started.
About Christopher Johns
Christopher Johns is a professor of nursing who developed the Model for Structured Reflection (MSR), a practice intended to offer a comprehensive guide to reflection in the nursing profession. Originally published in the early 1990s, Johns has continually developed and revised his model over the last two decades.
The model was designed for use by students and professionals alike. It provides a framework that can be used to reflect on any aspect of nursing practice or education.
Carper’s Fundamental Patterns of Knowing in Nursing
The structure of Johns’ Model of Reflection is based on Carper’s Fundamental Patterns of Knowing in Nursing (1978). Therefore it is useful to have an understanding of Carper’s work.
Carper argues that there are four primary sources of knowledge. They are:
- Empirics – the science of nursing
- Aesthetics – the art of nursing
- Personal – personal knowledge in nursing
- Ethics – moral knowledge in nursing
She goes on to explain that these sources must be used together to provide effective nursing practice. For example, simply using empirical theoretical knowledge is not enough – nursing requires creativity from aesthetic knowledge to provide care that can achieve positive outcomes for the unique individual, as well as personal knowledge of the situation to build a bond of trust between patient and practitioner and ethical knowledge to work within the framework of what is right and moral.
Johns’ Model of Structured Reflection
Along with the four variations of knowing implemented by Carper in the Knowledge Pattern (empirical knowledge, personal knowledge, ethical knowledge, and aesthetic knowledge), Johns added another domain, which he termed reflexivity or knowledge obtained from past experience.
This formed the foundation of his Model for Structured Reflection (MSR), which is essentially a series of cue questions to support the reflective practitioner to consider all aspects of an experience and derive meaning and learning from it.
These cue questions, as written by Johns in Transforming Nursing Through Reflective Practice (2009), as well as the associated way of knowing have been provided below.
|Reflective cue||Way of knowing|
|Bring the mind home|
|Focus on a description of an experience that seems significant in some way||Aesthetics|
|What particular issues seem significant enough to demand attention?||Aesthetics|
|How were others feeling and what made them feel that way?||Aesthetics|
|How was I feeling and what made me feel that way?||Personal|
|What was I trying to achieve, and did I respond effectively?||Aesthetics|
|What were the consequences of my actions on the patient, others and myself?||Aesthetics|
|What factors influenced the way I was feeling, thinking or responding?||Personal|
|What knowledge informed or might have informed me?||Empirics|
|To what extent did I act for the best and in tune with my values?||Ethics|
|To what extent did I act for the best and in tune with my values?||Ethics|
|How does this situation connect with previous experiences?||Reflexivity|
|How might I respond more effectively given this situation again?||Reflexivity|
|What would be the consequences of alternative actions for the patient, others and myself?||Reflexivity|
|How do I NOW feel about this experience?||Reflexivity|
|Am I more able to support myself and others as a consequence?||Reflexivity|
|Am I more able to realise desirable practice monitored using Reflexivity appropriate frameworks such as framing perspectives, Carper’s fundamental ways of knowing, other maps?||Reflexivity|
As you can see, each of the cue questions are linked to one of the fundamental ways of knowing and can be used to get a full picture of the experience before reflecting on what can be learned from it and how the experience may inform future practice.
The aesthetic questions are concerned with what happened during the experience and what were the consequences. We might write a factual and objective description of the scenario and what we were thinking whilst it was happening.
The personal questions help us to consider our feelings during the experience and the influencing factors that may have contributed to these emotions.
The empirical questions explore how our knowledge (or lack of knowledge) may have informed the experience. We might think about how our training, theory and academic literature played a part in the experience.
The ethical questions help us to frame the experience in relation to our own personal values. We might also consider professional codes and best practices.
Finally, reflexive questions help us to get meaning from the experience and identify what we have learned from the situation. We might look at how we feel now and what we might do differently if a similar situation in the future.
Advantages and Disadvantages of Johns’ Model of Reflection
There are several pros and cons to Johns’ model of structured reflection, which we will explore below.
Advantages of Johns’ model include:
- It is very detailed and the questions help to develop a holistic viewpoint of the situation which facilitates deeper thinking
- It considers the viewpoints of others and the influence of values and ethics, which s not present in other models
- Johns has produced a lot of literature in relation to reflective practice, so it is underpinned by a lot of theory
- Johns has tested and validated his model in practice
Disadvantages of Johns’ model include:
- The detail of the model and the volume of associated literature mean that the model can be quite complex and require a lot of time and effort to understand and use
- The complexity can also make the model appear to be very prescriptive and lack flexibility
- Unlike other models, Johns’ MSR does not explicitly connect our learning to the creation of an action plan
Alternatives To Johns’ Model of Reflection
Here, we will discuss alternative models of reflection that may be used to overcome some of the disadvantages of the Johns model.
Kolb’s reflective cycle is a lot less complex than Johns’ model because it is made up of a simple 4-step process:
- Concrete experience – the experience
- Reflective observation – reflecting on the experience
- Abstract conceptualization – new insights and perspectives gained
- Active experimentation – putting the new learning into practice
The simplicity of this model means that there is flexibility for the practitioner to cover only the areas that they deemed important to the experience, which can be useful if time is limited. The caveat is that important areas may be quickly dismissed or inadvertently omitted from the process that may result in missed learning opportunities.
Gibbs’ reflective cycle builds on that of Kolbs and whilst it is slightly more complex, it is still a lot simpler than Johns’ model. Both Kolb and Gibbs also emphasise the process of developing an action plan, so that the learning can be put into practice following self-reflection.
Although Atkins and Murphy’s framework for structured reflection is still quite complex, it is slightly less so than that of Johns. It also has a lot of emphasis on self-awareness and open-mindedness that can help us to challenge our innate or longstanding prejudices that may influence our practice.
As with Johns’ model, Atkins and Murphy’s work was also developed for use in the nursing profession.
An Example of Johns’ Model of Reflection
A great practical example of using Johns’ Structured Model of Reflection is provided by Johns in his paper Framing learning through reflection within Carper’s fundamental ways of knowing in nursing.
This describes the experience of a nurse working in a corporate occupational health department when an employee refers themselves after having taken drugs. The employee gives a bag of drugs to the nurse so that they know what they have taken before becoming agitated, resulting in the nurse calling security and an ambulance. The nurse had wanted to protect the employee and said that they would not report it this time and disposed of the drugs in the bin but fished them out when the ambulance arrived having felt it was important to their wellbeing. The vice-president became away of the situation and asked the nurse what had happened. The nurse provided an honest account and the employee was fired from their job.
- The nurse’s lack of knowledge in relation to substance use and reactions to drug-taking
- Nurse did not know employee well
- Nurse disapproved of drug-taking but had empathy towards patient and so took a ‘critical mother’ approach to the interaction
- Nurse felt an element of anxiety/panic during the experience
- The dilemma between the confidentiality of the patient and the responsibility to report substance use to the employer
- Guilt following the employee losing their job
- The nurse feels they should learn more about substance abuse
- The nurse feels that they behaved appropriately during the experience but still feels a sense of guilt about the employee being sacked
- The nurse considers approaching the vice-president to ask for the employee to be reinstated to help with their guilt
- The nurse recognises that they have not yet approached the vice-president through a lack of assertiveness and wanting to avoid conflict – this consequently made them feel angry and frustrated
- The nurse will use this experience to improve their practice as well as supporting other team members that may have similar experiences
- Carper, B. (1978). Fundamental Patterns of Knowing in Nursing
- Johns, C. (1995). Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. Journal of advanced nursing, 22(2), 226-234
- Johns, C. (1996). Visualizing and realizing caring in practice through guided reflection. Journal of Advanced Nursing, 24(6), 1135-1143
- Johns, C. (1999). Reflection as empowerment?. Nursing Inquiry, 6(4), 241-249
- Johns, C. (2009). Guided reflection: Advancing practice. John Wiley & Sons
- Johns, C., & Freshwater, D. (Eds.). (2009). Transforming nursing through reflective practice. John Wiley & Sons
- Johns, C. (Ed.). (2017). Becoming a reflective practitioner. John Wiley & Sons.