Assessment of clinical nursing education with the AssCE tool

The purpose of the AssCE tool is to support and clarify learning outcomes in clinical courses and in the assessment of the student' s development. The AssCE tool can also be helpful in giving continuous feedback during clinical practice and can be useful for students in formulating their own learning outcomes before a clinical practice period.

Assessment tools

The forms are available for viewing below and if you would like to use them, please contact:

Anna Löfmark, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle. E-mail:

Anita Nyström, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle. E-mail:

Indicate on what educational level you intend to use the AssCE tool and which higher education institute you are affiliated with. 

Assessment tool AssCE

The forms are available below

The AssCE tool, basic and advanced level

During clinical practice in nursing programme, in specialist nursing programmes and in the midwifery programme, it is the responsibility of the nurses who are preceptors for the students to support the students in their development, but also to assess to what degree students have progressed in their knowledge and understanding, in competence and skills and in judgement and approach. These concepts are general descriptions of goals in programmes at university level. In the different course syllabuses where clinical practice is included, these goals are expressed as learning outcomes that must be attained. The level of the student’s performance in attaining learning outcomes decides the student’s grade for the course in question. The purpose of the AssCE tool is to provide guidance and clarify learning outcomes when assessing the student’s development. It is also a responsibility of the student to assess their own achievements within the areas mentioned above.

The AssCE tools are developed in accordance with Swedish higher education regulations (SFS 1992; SFS:1993) and international guidelines for nursing education (ICN 2008). The AssCE tools for basic and advanced level programmes comprise of 21 factors divided into five areas. The factors are described for two different levels of goal attainment, Good achievement of goals and Very good achievement of goals, and clarify the level of knowledge and student development within a factor. The AssCE tools have a general content and applies to each programme as a whole, which means that different factors in the tools can vary in emphasis and importance depending on the learning outcomes in each specific course.

The AssCE tools could be used not only during mid-course discussions and final assessments, but also as support in giving continuous feedback during clinical practice periods, and when the students formulate their own learning outcomes before a clinical period. In the AssCE instructions, there is additional information on how to use the tools during clinical education. 

The development of the assessment tools

The AssCE tool for basic level has been in use since the late 1990s. The tool has been continuously revised according to comments in evaluation studies on the feedback made in evaluation studies (Löfmark & Thorell-Ekstrand 2000; 2004; 2014).and from discussions and changes suggested in workshops held in 2013 and 2014, Recent publications on the AssCE tool include a validation study (Löfmark & Mårtensson, 2017), and a study by Engström et al. (2017) confirms that AssCE tool supported students' learning and that the AssCE tool was supportive regarding to what degree assessment discussions focused on students´ knowledge, skills and professional judgement. Yet another study, by Vae et al. (2018) shows that student and preceptor (as pairs) have both shared and disparate opinions and experiences of assessment dialogues. Student and preceptor both described that the AssCE tool gave support in their discussions, but there was an uncertainty regarding the preparations before the assessment discussions. The study also showed that the feedback given to students had more focus on what students should practice on and develop, rather than on giving constructive feedback.

The AssCE tool for advanced level was developed in its first version in 2008, and has been developed and transformed over time. Content, use and suggestions for revisions have been discussed in a total of six workshops in the time period 2014 - 2018. A revised version of the AssCE tool and an instruction common to all specialist nursing programmes are in use since the autumn semester of 2015. An AssCE tool for the midwifery programme has been developed and is in use in a number of universities since the spring term of 2016. Experiences of using this new version are continuously followed up in workshops. The next workshop is scheduled to be held in April of 2019. A validation study for advanced level has been conducted but is yet to be published.

The following publications contain studies on the AssCE tool

(recent studies are places first)

Vae, KJ., Engström, M,. Mårtensson, G., Löfmark, A. (2018). Nursing students' and preceptors’ experience of assessment during clinical practice. A multilevel repeated-interview study of student-preceptor dyad. Nurse Education in Practice 30, 13-19.

Engström, M,. Löfmark, A,. Vae, KJ,. Mårtensson, G. (2017) Nursing students' perceptions of using the Clinical Education Assessment tool AssCE and their overall perceptions of the clinical learning environment - A cross-sectional correlational study. Nurse Education Today 22 (51), 63-67.

Löfmark, A., Mårtensson, G. (2017). Validation of the tool assessment of clinical education (AssCE): A study using Delphi method and clinical experts. Nurse Education Today 50,82-86.

Löfmark, A..,Thorell-Ekstrand, I. (2014). Nursing students’ and preceptors’ perceptions of using a revised assessment form in clinical nursing education. Nurse Education in Practice 14(3), 275-80.

Löfmark, A., Thorell-Ekstrand I. (2004). An assessment form for clinical nursing education: A Delphi study. Journal of Advanced Nursing 48, 291-298.

Löfmark, A., Thorell-Ekstrand, I. (2000). Evaluation by nurses and students of a new assessment form for clinical nursing education. Scandinavian Journal of Caring Sciences 14 (2), 89-96.

Other literature

International Council of Nurses (ICN) (2008) Nursing Care Continuum-

Framework and Competencies. (accessed 12 February 2015).

Swedish Higher Education Act (SFS 1992:1434) Stockholm: Ministry of Education and Research.

Swedish Higher Education Ordinance (SFS 1993:100 altered 2018:1503). Stockholm: Ministry of Education and Research.


1. May we at our university try using the AssCE tool in the nursing programme and/or in specialist nursing education?

Response: Yes, contact Anna Löfmark or Anita Nyström (see contact information above) and indicate what level of education you would like to use the AssCE tool for and the university you are working at. If you supply this information, you can be invited to future workshops.

2. May we use the logotype of our own university on the front page of the tool?

Response: Yes, you may.

3. May we rephrase some of the factors or the text describing the factors to make them better correspond to our own learning outcomes?

Response: No, the content of the tool is protected by copyright. This is made clear in the footnote, which also states the owners of the copyright.

Published by: Julia Högnelid Page responsible: Annika Strömberg Updated: 2019-05-14
Högskolan i Gävle
Box 801 76 GÄVLE
026-64 85 00 (växel)