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Johns Model of Structured Reflection

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For this placement I was on an elderly male medical ward. As I have had no previous experience of care in a healthcare setting their where numerous thing with which I had to a customise myself with.

Johns Model of Structured Reflection (Johns 1998)

1.Write a description of the experience. Ask yourself:

*’What are the significant issues I need to pay attention to?’

On my first day on the ward it was decided that I should shadow one of the staff nurses to acustomise myself with the ward. During this induction we had to assist an elderly gentleman with sever diarrhoea the gentleman in question was quit large and almost completely immobile. On inspection of the patient he was incontinent of both urine and faeces the staff nurse then talked with the patient explaining to him what had happened and that we needed to clean him and change his bedding. It was very difficult to understand what he said in reply because as I found out later he was also suffering from sever oral thrush making it painful for him to open or move his mouth. We began by removing the top sheet and counterpane and it was decided that because the patient was lying slightly to the left we would role him towards the staff nurse leaving me to do the majority of the cleaning.

As I had never encountered anything like this before I was getting more and more flustered as to what to do and whether I was doing it correctly and each time the patient moaned in pain I felt worse. the staff nurse with me was helpful but as she would have done this kind of thing hundreds of times she was not very instructive as it probably seemed perfectly obvious what to do and how to do it. Each time I did something I was thinking what now, how do I do this and slowly convinced myself that I was hopeless and incapable of even changing a bed. Whilst rolling the patient over towards me to remove the old sheet I started to feel hot and dizzy the nurse working with me noticed this almost straight away called for some help to take my place and took me to the visitors’ room to sit down and recover.

2.Explore the experience using the reflective cues:

*Aesthetic: Ask yourself:

a)-‘What was I trying to achieve?’

b)-‘Why did I respond as I did?’

c)-‘What were the consequences of that for:

*The patient?



d)-‘How was the person(s) feeling?’

a) We where trying to clean and change the patient to make him more comfortable with minimum pain and distress.

b) I think I responded as I did because of several factors. firstly I was very nervous about being on a new ward with all new surroundings and people, I had never come into close contact with a completely immobile patient who relies on someone else to do everything for them, I was very conscious as to whether I was doing the right thing or not and it was quite warm on the ward all of these factors contributed to me felling out of place getting flustered and the panic reaction.

c) * For the patient I can only guess that it was distressing. On reflecting my moving techniques where not positive enough so instead of moving him with ease and control he was shuffled round causing undue discomfort. Also as time was taken to attend to me the time it took to complete looking after the patient was increased prolonging his discomfort.

* For the other staff I suspect they thought nothing of it and continued on as normal but it would have been a disturbance for the nurses who had to leave what they where doing to take my place

* The consequences for me were that I lost confidence in my abilities to deal with difficult situations and to control my nervousness.

d) At the time I thought the patient was getting annoyed with me because of my incompetence in reflection I think he would not have noticed me any more than any other nurse their.(I never got chance to speak with him again as he passed away during the night). Also I thought that I was being sneered at by the other nurses as I was so uncoordinated but after talking with them over the course of the placement I discovered they thought I did well as a hole on my first day.

*Personal: ask your self:

-‘How did I feel in this situation?’

-‘What internal factors were influencing me?’

Firstly I felt nervous at the start as I was doing things I had never encountered before I was also apprehensive about how well I would perform in front of the other nurses. as the procedure went on I became flustered and more nervous which made me even more jittery and I started to loose track of what I was doing this made me annoyed with myself, all this combined made me suddenly feel very hot and dizzy I tried to concentrate on what I was doing but it was impossible. After I had recovered I just felt a bit stupid and embarrassed.

*Ethics: ask yourself:

-‘Did my actions match with my beliefs?’

-‘What factors made me act in incongruent ways?’

Before I started on the ward I believed that I could handle any situation presented to me as I have a very logical mind and can work my way around problems. What I was not prepared for was the closeness of contact with patients. I knew I would have to deal with this type of situation but I was not prepared for my reaction it felt very out of place for me I have never responded in such a way before or since. I’m not sure why I acted the way I did I guess it was just lack of confidence and internal pressures to do well.

*Empirics: ask yourself:

-‘What knowledge did or should have informed me?’

There are hundreds of books on the market related to confidence goal setting and self belief. All of which are probably very good if you are aware of a problem within yourself and wish to build these skills to cope with any situation but in my opinion you can’t beat practice the more you practice something no mater what it is you will improve.

*Reflexivity: ask yourself:

-‘How does this connect with previous experiences?’

-‘Could I handle this better in similar situations?’

-‘What would the consequences be of alternative actions for:

*The patient?



-‘how do I now feel about this experience?’

-‘can I support myself and others better as a consequence?’

-‘has this chanced my way of behaving?’

:-In previous experiences where I have been placed in new surroundings and expected to do something new I seem to have handled it ok I think the reason I acted differently in this situation is because during the time at university it is stressed how important it is to do everything correctly even down to the correct posture as not to hurt your back, so I was trying not to do anything wrong putting to much pressure on myself

:-From this point on I gained more confidence as the one or two of the nurses took this incident as something to talk to me about in a joking fashion so on getting to know the staff put me at ease and the next time we had to wash a patient I was fine and more confident. And now I have developed the basic caring skills when I move onto my next ward I will have knowledge of what to expect and prepare myself accordingly.

:-If I had had this knowledge then the whole incident would have gone by much more smoothly with no interruptions and less discomfort for all involved.

:-I still look back with slight embarrassment at the whole situation but I believe it has put me in much better stead for dealing with situations of a similar nature in future. This incident has changed my way of approaching something new now I have a go and realise that if it is my first attempt at something I am bound to make mistakes and to learn from those mistakes.


Johns. C., Freshwater. D. (1998) Transforming nursing through reflective practice. Bailliere’s Study Skills for Nurses Vol 2 Bailliere Tindall pp

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