The Basic Knowledge Assessment Tool (BKAT)
For Pediatric Critical Care Nursing, Version Five, 
PEDS-BKAT5r© 2006

 

Introduction

 

            Basic knowledge in critical care nursing is a body of knowledge beyond that required for licensure as an RN that the critical care nurse uses in order to provide safe nursing care to patients.  Since safe practice is regarded as a moral and professional responsibility, basic knowledge is information that is necessary for entry into critical care nursing and represents the foundation for job performance.

 

            A primary aim of in-service education in critical care nursing is to assure that staff nurses demonstrate an understanding of this basic knowledge.  Because of on-going research studies (since 1979), publications, and the use of the BKAT over the past 29 years, it has become accepted as one standard for measuring basic knowledge in critical care nursing.  To date, over 7,500 critical care nurse educators and nurse managers in the USA have requested and have received a copy of one of the BKATs to photocopy for use in their practice.  Critical care nurses in over 23 different foreign countries have also requested and received a copy of one of the BKATs.

 

The PEDS-BKAT

 

The PEDS-BKAT4

            The initial PEDS-BKAT4 (Version Four) was developed in 1996 and has been in use since that time in Pediatric ICU’s across the USA.  Content for the PEDS-BKAT4 was identified through a review of the literature and interviews with staff nurses and nurse managers working in the PICU.  Based on the adult version of the BKAT (Version Four), a 10 member Panel of Experts in PICU nursing were convened.  Of the 100 items on the adult BKAT-4, 20 were deleted and 20 new questions (items) appropriate to the PICU were added.  An additional 10 items were modified.  Reliability of the PEDS-BKAT4 was measured on 113 nurses working in the PICU who answered the test.  The reliability coefficient (Cronbach’s coefficient alpha) was 0.86, with a mean score of 78.7 points and a standard deviation (SD) of 9.8.

 

The PEDS-BKAT5

 

            Content validity and the Panel of Experts.  The PEDS-BKAT5 is a 90 item paper and pencil test that measures basic knowledge in PICU nursing.  Based on the previous version of the test (the PEDS-BKAT4), Version Five was developed through the use of a seven member Panel of Experts working as nurse managers and clinicians in the PICU.  Of the seven, five held a masters degree in nursing.  All but one stated they held certification(s).  These included CCRN, RNC, CRNP, PCCNP, APRN, CCNS, ARNP, and CPNP.  Changes were made in Version Four based on the comments of the Panel members.  This included updates and a rating of the basicness of each item on the test on a scale of 1 to 5 with ‘1’ being the most basic to safe practice in a PICU and ‘5’ being the least basic.

 

            Revisions that resulted in the PEDS-BKAT5 included the following:  1)  the deletion of 21 items, 2) writing of 5 new items, 3) use of 5 items from the new adult BKAT (Version 7, 2006), 4) use of 7 items from the new BKAT for the Neonatal ICU (NICU-BKAT3, 2004), and 5) the revision of 44 items.  Changes to these included modification of stems, answers, and/or distractors to improved clarity and to update current practice situations described in the items.  Only 14 items were not changed.

 

            Content areas.    Content areas of the PEDS-BKAT5 include the following:

• Cardiovascular, 23 items (cardiac output, EKG interpretation, electrical/emergency situations, drugs),
• Monitoring lines, 6 items (arterial, CVP),
• Pulmonary, 13 items (ventilators, pulmonary assessment/care),
• Neurology, 12 items (assessment/care, drugs),
• Endocrine, 8 items (diabetes mellitus, drugs, stress),
• Renal, 11 items (assessment/care, peritoneal dialysis/CVVH),
• GI/parenteral, 6 items (nutrition, GI bleeding), and
• Other, 11 items (child’s play, drug OD, family centered care).

 

Construct validity was supported through the use of the technique, Known Group Differences, comparing the scores on the PEDS-BKAT5 of 140 USA pediatric ICU nurses scores to 22 Pediatric ICU nurses in Nepal.  The nurses working in Nepal were hypothesized as different because of differences in nursing practices in their Pediatric ICU, differences in the drugs used, and differences in the cultures.  It was expected that the PEDS-BKAT5 would measure the difference.  It did.  Also, it was expected that because of the differences, that the Nepal nurses were at a disadvantage that would lead them to scoring lower than the USA nurses.  This happened, too. 

 

A t-test for independent groups was used and was t(160)=12.8, p<.0005, significant.  The average score of the nurses in Nepal was 48.2 points (50.2% correct answers) and the average score of the USA nurses was 75.3 points (78.4% correct answers).  The standard deviation of the scores between the two groups was equal with 10.8 points for the Nepal nurses and 9.0 points for the USA nurses.

 

Reliability.  The reliability of the PEDS-BKAT5 was measured on a sample of 131 nurses working in PICU’s from the following 18 states:  Arizona, California, Georgia, Florida, Illinois, Indiana, Louisiana, Maine, Michigan, Minnesota, Missouri, Mississippi, Ohio, Oregon, South Carolina, Virginia, Washington, and West Virginia; and from Canada. 

 

The reliability coefficient (Cronbach’s coefficient alpha) was 0.85, with a mean score of  75.3 points (78.4%) and a standard deviation (SD) of 9.0.  The percent correct answers ranged from 54.2%-96.9%.

 

            Passing Score.  The PEDS-BKAT5 takes approximately 40 minutes to complete.  The total possible score is 90 points.  Items on the PEDS-BKAT5 contain multiple choice and fill-in-the-blank questions that measure both the recall of basic information and the application of basic knowledge in practice situations.  Psychosocial aspects of PICU nursing practice are integrated into specific questions in the PEDS-BKAT5.

 

No one is expected to achieve 100%.  Rather, it is expected that following orientation, PICU nurses will achieve an average score of approximately 78% to 80% correct answers.  Whether or not a score is considered to be a passing grade depends upon which specific questions are missed; for example, being able to recognize the EKG pattern of ventricular fibrillation is critical to know in any unit.  Since the PEDS-BKAT5 is being used in a wide variety of clinical settings, which specific questions are essential to know for that setting is decided by the nurse administering the PEDS-BKAT5.

 

Uses of the PEDS-BKAT5 

The PEDS-BKAT5 can be used during orientation classes in the PICU to identify content for the classes, and as a pretest and/or a posttest to measure learning in groups of nurses.  It can also be used as a dependent variable to test different methods for orientation classes, and as a means to identify content for in-service education programs for currently employed PICU nurses. 

 

In addition, it has been successfully used for advance placement of nurses with prior experience in PICU nursing, so that they do not have to attend classes that present content they already know. 

 

The BKAT is only one measure of basic knowledge in critical care nursing and is not to be used in screening, hiring, or firing situations.  It is copyrighted ^© and may not be altered, added to, or used in part.  Permission must be obtained to use the BKAT. No BKAT may be put on any computer for any reason.

 

Requests for Copies of the PEDS-BKAT5

 

Contact Dr. Jean C Toth, RN, PhD, (toth@cua.edu).

 

Panel of Experts or the PEDS-BKAT5

Linda Alwine, RN, MSN, South Carolina
Laurie Finger, RN, APRN, MN, CCRN, CCNS, Louisiana
Tamra Haymans-Benedict, RNC, CCRN, Georgia
Kelly Keefe Marcoux, RN, MSN, PCCNP, New Jersey
Kim Miller, RN, MSN, ARNP, CPNP, Florida
M Heather Paterson, RN, BS, CCRN, Texas
Shari Simone, RN, MS, CRNP, Maryland

Data Collectors for the PEDS-BKAT5

Melanie Akers, RN, BC, MSN, West Virginia
Linda Alwine, RN, MSN, South Carolina
Cathy Ashton, RN, MSN, CCRN, Florida
Lynn Beach, RN, MSN, California
Bernita Boviee, RN, MSN, BC, Oregon
Ramanand Chaudhary, RN, Nepal, Asia
Joanne Coleman, RN, MSN, Mississippi
Charlene Cunningham, RN, MSN, CCRN, Georgia
Rachel Dalleish, RN, MSN, PNP, Maine
Merri Frank, RN, MSN, CCRN, Ohio
Cathy Geisen, RN, Illinois
Norma Hall, RN, BSN, BC, Indiana
Debra Kilpatrick, RN, CCRN, Indiana
Cathy Kolbe, RN, MSHA, Arizona
Lisa Koser, RN, BSN, Ohio
Grace MacConnell, RN, MN, CNCCP(C), Canada
Marilyn Maddox, RNC, CCRN, Missouri
Tracie Major, RN, MSN, CPN, Louisiana
Wendy Murchie, RN, BSN, CCRN, Washington
Eileen Murray, RN, BSN, Georgia
Nancy Runton, RN, MSN, CRNP, Virginia
Margaret Sourbeer, RN, MSN, Virginia
Lynn Swift, RN, MS, Minnesota
Rose Szeles, RN, BSN, Virginia
Sue Thomas, RN, BSN, CPN, Illinois
Robin Watson, RN, MN, CCRN, California
Chasity Wellnitz, RN, BSN, MPH, Arizona

 

Authors of the BKATs

 

The initial version of BKAT (BLAT1) was co-authored by Jean C Toth, RN, CNS, BC, MSN, PhD, The Catholic University of America, Washington, DC and Kathleen Ritchey, RN, CNS, MSN, formerly of the Veterans Affairs Medical Center, Washington, DC.

 

Other BKATs Available

 

            BKAT-7 for Adult Critical Care (2006)

            BKAT-5S for Telemetry/Progressive Care (2001) (BKAT-7S available Spring 2007)

            NICU-BKAT3 for Neonatal ICU (2004)

            ED-BKAT for the Emergency Department (2006)

 

Selected References

 

Collins ML, Thomas TL.  Creation of a stepdown nurse internship program.  Journal for Nurses in Staff Development.  2005;May/June:115-119.

 

Herdrick B, Lindsay A.   Nurse residency programs.  Journal for Nurses in Staff Development.  2006;March/April:55-62.

 

     Holcomb S, Posea K. Homegrown: CC interns take root.  Nursing Management. 2001;32(5):38-39.

 

McConnell EA, Fletcher J, Nissen JH. A comparison of Australian and American registered nurses’ use of life-sustaining medical devices in crit care & high-dependency units. Heart Lung. 1993;22(5):421-427.

 

Messmer PR, Jones SG, Taylor BA.  Enhancing knowledge and self-confidence of novice nurses:  The “Shadow-A-Nurse ICU program.  Nursing Education Perspectives. 2004;25(3):131-136.

 

Messmer PR, Jones SG, Rosillo C.  Using nursing research projects to meet Magnet recognition program standards.  Journal of Nursing Administration. 2002;32(10):538-543.

 

Recker D, O’Brien C.  Reliability and validity of critical care orientation tests.  J Cont Educ Nurs.  1995;26(1):21-27.

 

Ritmala-Castren M, Leino-Kilpi H, Suominen T.  Biological & physiological knowledge & skills of graduating Finnish nursing students to practice in intensive care.  Nurse Educ Today.  2004;24(4):293-300.

 

Ritmala-Castren M, Suominen T, Leino-Kilpi H, Toth JC.  ICU nurses’ knowledge assessment.  American Journal of Critical Care.  2006 (in review).

 

Runton NG, Toth JC.  Introducing the Basic Knowledge Assessment Tool for pediatric critical care nursing (PEDS-BKAT).  Critical Care Nurse.  1998;18(3):67-72.

 

Sakallaris, BR.  The ICU fellowship:  An innovative orientation program for new graduates in critical care.  Focus on Crit Care.  1991;18:153-157.

 

Santiano N, Daffurn K, Lee A.  The Basic Knowledge Assessment Tool:  Is it useful?  Aust Crit Care.  1994;7(4):18-23.

 

Toth JC.  Follow-up Survey 10 years later:  Use of the Basic Knowledge Assessment Tools (BKATs) for critical care nursing affects on staff nurses.  Critical Care Nurse.  2006;26(4):49-53.

 

Toth JC.  Development of the Basic Knowledge Assessment Tool (BKAT) for the NICU:  The NICU-BKAT3, Its uses and effect on staff nurses.  Journal of Perinatal Neonatal Nursing.   2007;21(4) October-December.

 

Toth JC.  Comparing basic knowledge in critical care nursing between USA and foreign nurses:  An international study.  American Journal of Critical Care.  2003;12(1):41-46.

 

Toth JC.  Basic Knowledge Assessment Tool for critical care nursing, Version Four (BKAT-4):  Validity, reliability, and replication.  Critical Care Nurse.  1994;14(3):111-117.

 

Toth JC, Dennis MM.  The Basic Knowledge Assessment Tool (BKAT) for critical care nursing:  Its use and effect on orientation programs.   Critical Care Nurse.  1993;13(2):111-117.

 

Toth JC.  The Basic Knowledge Assessment Tool (BKAT)—Validity and reliability:  A national study of critical care nursing knowledge.  W J Nurs Res.  1986;8(2):181-196. 

 

Toth JC.  Evaluating the use of the Basic Knowledge Assessment Tool (BKAT) in  critical care nursing with baccalaureate nursing students.  Image:  The Journal of Nursing Scholarship.  1984;16(3):67-71.

 

Toth JC , Ritchey KA.  New from nursing research:  The Basic Knowledge Assessment Tool (BKAT) for critical care nursing.  Heart  Lung.  1984;13(3):271-279.

 

Wynd, C..  Evidence-based education and the evaluation of a critical care course.  Journal of Continuing Education in Nursing.  2002;33(3):119-125.