Johns' model of structured reflection: a worked example for CPD and revalidation

Some registrants find Gibbs too linear and Rolfe too sparse. Johns' model sits between them. It is more searching than a three-question prompt, and more focused on your feelings, your ethics and the knowledge you drew on than a simple cycle. This guide explains how it works, gives a worked example, and shows how to turn the result into an HCPC CPD entry or an NMC reflective account.

What Johns' model of structured reflection is

Johns' model, often called the Model for Structured Reflection, was developed by the nurse and academic Christopher Johns in the 1990s and has been revised through several editions since. It was written for nursing but is now used across the allied health professions and beyond.

Its distinctive idea is that good reflection is not just a description of events. It asks you to look inward at yourself and outward at the situation at the same time, and to notice the different kinds of knowledge you were relying on when you acted. It draws on Barbara Carper's 1978 account of the fundamental patterns of knowing in nursing, to which Johns added a fifth.

If you want to weigh it against the alternatives first, see which reflective model should you use and the dedicated guides to the Gibbs reflective cycle and the Rolfe model.

Looking in, and looking out

The heart of the model is a pair of movements.

• Looking in means turning your attention inward: what you were thinking and feeling at the time, and what those feelings tell you now.
• Looking out means turning your attention to the situation: what happened, who was involved, what you were trying to achieve, what influenced your decisions, what the consequences were, and how it fits with your professional values.

Holding both together is what stops a reflection collapsing into either a dry incident report or an unstructured emotional download.

Carper's ways of knowing, and Johns' fifth

Johns organises the looking out around the kinds of knowledge a practitioner uses. Barbara Carper described four.

• Empirical: the factual, evidence-based knowledge you applied, such as guidelines, physiology or research.
• Aesthetic: your reading of the whole situation in the moment, the art of practice, including your perception of the person in front of you.
• Personal: your self-awareness, and the way your own assumptions and your relationship with the person shaped what you did.
• Ethical: the values and moral judgements involved, including any tension between what was right and what was easy or expected.

Johns added a fifth, reflexivity: looking back across your past experience to see how this situation connects to it, and how it should change what you do next. Reflexivity is where a reflection earns its place, because it turns insight into a plan.

The cue questions

In practice you work through a set of cue questions. The exact wording has changed across editions, but they typically prompt you to consider:

1. A brief description of the experience, and the key issue that made it significant.
2. What you were trying to achieve, and why you acted as you did.
3. What you were feeling at the time, and what you think the other people involved were feeling.
4. What the consequences were, for the person, for others and for you.
5. What internal and external factors influenced your decisions.
6. What knowledge did, or should have, informed you, using the ways of knowing above.
7. How this experience connects with previous ones, and what you now understand differently.
8. How you would respond if the situation arose again, and how you feel about the experience now.

You do not have to answer every cue for every event. Use the ones that open the situation up.

A worked example

The example below is fictional and anonymised. It shows the model applied in a compressed form, not a full transcript.

Looking out (description and aims). On a late shift I cared for an older patient whose early warning score had crept up slightly across two sets of observations. Nothing was dramatic, and the patient said they felt just tired. My aim was to keep them safe without over-reacting to a borderline picture. Looking in (thoughts and feelings). I felt a pull to wait for the next set of observations rather than trouble a busy senior colleague. Underneath that was a worry about looking inexperienced. Ways of knowing. Empirically, I knew that a rising trend matters more than a single reading. Aesthetically, something about the patient's quietness did not sit right. Personally, I could see my hesitation was about my own confidence, not the clinical picture. Ethically, my duty to the patient outweighed my discomfort about escalating. Reflexivity and action. I have hesitated to escalate before and later wished I had acted sooner. This time I escalated, the patient was reviewed, and treatment was brought forward. In future I will treat a rising trend as a reason to escalate early, and I will read my own hesitation as a prompt to act rather than wait.

Notice how the reflection ends with a concrete change, not just a feeling. That is what an assessor or a confirmer is looking for.

How to turn it into a CPD entry or reflective account

Johns' model produces the raw material. You then shape it for your regulator.

For the HCPC, reflection is a recognised CPD activity, and the HCPC does not require any particular model or a set number of reflections. If you are selected for audit, you need to show that your CPD has contributed to the quality of your practice and to service delivery. The reflexivity and action part of Johns' model is exactly that evidence. See what to record for HCPC reflective practice.

For the NMC, you must prepare five written reflective accounts across your three-year cycle, each recorded on the NMC's approved form and each linked to the Code. Johns' looking out and reflexivity feed the boxes on what you learned and how you changed your practice, and the ethical strand helps you connect the account to the relevant part of the Code. See the field-by-field guide to the NMC reflective account form.

When to reach for Johns, and when not

Johns' model rewards the effort on complex, emotionally significant or ethically uncomfortable situations, where the value is in the depth. For a straightforward study day or a short course, a lighter approach is usually enough and a simpler structure will do the job. See how to write a reflection on a course or study day.

A note on difficult events

Because this model asks you to look inward, it can surface distressing memories. Reflection is structured learning that moves towards a change in practice. Rumination is going over the same distress without resolution, and it does not help you or the people you care for. If an event is still weighing on you, that is worth taking seriously rather than writing your way around it. Your occupational health service and your union can help, and the Samaritans are available free at any time on 116 123.

Writing it up with Reflectory

If the blank page is the hard part, Reflectory can help. It interviews you about the event one question at a time, in the spirit of Johns' cue questions, and produces a reflective account in your own words. Identifiable details are screened out as you go, and a note disclosing the use of AI assistance is built in, so the finished account is honest, structured and ready for your HCPC or NMC portfolio.