The students' perceptions of learning clinical judgment in undergraduate nursing education were investigated using grounded theory methodology. Informants were seventeen students and five new graduates of two baccalaureate degree nursing programs in the Midwest. Data were collected using formal interviews, participant observation, review of selected course materials, and review of related research. Data were analyzed using constant comparison.

Analysis of the data resulted in the development of a preliminary theoretical model of nursing students' perceptions of learning clinical judgment. The core concept of the model is competence validation, a construct describing the process by which the student's identity as a competent nurse is established. The outcomes of competence validation vary according to students' perceptions of educational context: an evaluation context and a learning context.

Within a learning context, the student is intrinsically motivated to develop knowledge and skills necessary to solve patient problems and make clinical judgments. The student develops some degree of cognitive flexibility, the ability to find and apply information that is appropriate for patient problem solution. Cognitive flexibility is an important determinant of the student's ability to learn independent judgment. By achieving the ability to independently identify and apply information relevant to patient-centered problem solution, the student develops a self-perception of competence.

Within an evaluation context the student's educational activities are extrinsically motivated by a desire to satisfy formal and informal evaluation contingencies. As a result of the student's focusing efforts on meeting evaluation contingencies, the student develops some degree of cognitive rigidity, the negative extreme of cognitive flexibility. In an evaluation context, the student's competence is validated by achievement of satisfactory grades.

The theoretical model is in the early stages of development. However, the theoretical model, grounded in the students' perceptions, offers a framework for further theory development and research in nursing education.