Content for the initial version of the BKAT was identified through a review of the literature and interviews with staff nurses and head nurses working in critical care units, and through the suggestions from two critical care physicians and a nine member panel of experts in critical care nursing practice and education.  Validity of previous versions of the BKAT has also been supported through replication of research findings related to group differences, learning theory, and variables associated with (and not associated with) scores on the BKAT.

Content validity.   Content validity for the BKAT-7 was supported through research findings on previous versions of the BKAT and through a six member Panel of Experts from the following five states:  Arizona, Colorado, Tennessee, Texas, and Virginia.  The Panel was used to validate that items are basic to safe nursing practice in critical care units.  Each item was rated from 1 to 5 points with 1 being the most basic and 5 representing more advanced knowledge.  No item was rated with a 5.  Items were deleted if they were rated not to be basic knowledge and/or if they were outdated.  The BKAT-7 was based on the BKAT6.  Ten items were deleted and replaced by new items, many of which were suggested by the Panel.  In addition, 40 items were revised to reflect current knowledge and practice, to improve discrimination ability, and to improve clarity.  Reliability was conducted following these revisions (see below).

Construct validity.   Construct validity of previous versions of the BKAT was supported through samples of baccalaureate nursing students and new graduate nurses, groups known to be different from practicing critical care nurses.  The mean (M) BKAT scores of the students and the new graduates were, as expected, significantly lower than the M scores of the nurses. 

Construct validity for the BKAT-7 was again supported through the use of known group differences in which the BKAT-7 scores of 172 RNs working in ICUs were compared to 26 new graduate nurses (zero to 6 months experience in ICU).  The mean score for the RNs was 82.3 points (SD = 10.7) and the alpha reliability was 0.90; the mean score for the new graduates was 74.8 points (SD= 11.7).   The alpha reliability on the new graduates was 0.89.  A one-tailed t-test was found to be significantly different with the experienced critical care nurses scoring higher on the BKAT-7 than the new graduates, a finding that was expected t(194)= 3.9, p<001 .       

In addition, two groups that are ‘known’ to be different in previous research findings, student nurses (N=6) and Asian critical care nurses (N=9), were also compared.  The average scores on the BKAT-7 were a mean of 68.0 for the second year associate degree (AD) students (SD =  10.0).  The Asian critical care nurses, reported to have been brought into the USA to work in critical care units, had a mean score of 72.1 points (SD = 5.1). 

Two one-tailed t-tests were computed and found to be significantly higher for the experienced ICU RNs and the students [t(176)=3.2,p=.002] and the Asian nurses [t(11.6)=5.1,p<.001].  Interestingly, the variance of BKAT scores for the experienced critical care nurses, the new graduates working in critical care, the AD students were all equal.  However, the variance for the USA and Asian critical care nurses was not equal, or the two groups failed to show homogeneity. The alpha reliability for the BKAT-7 for the AD students was 0.87.  However, the reliability of the BKAT-7 for the Asian nurses was 0.49, again suggesting differences in critical care nursing between the two countries.

Reliability and Average Scores

            BKAT-1 through BKAT-6.  Cronbach’s Coefficient Alpha (a) has been used as the measure of internal consistency for all versions of the BKAT.  Reliability of the first two versions of the BKAT that was computed on two samples of critical care nurses (N=100 & N=92) and on a sample of baccalaureate nursing students (N=38) from the Washington, DC metropolitan area ranged from a = 0.83 to 0.86.  Reliability of Version Three of the BKAT that was computed on a national random sample of 84 nurses who were members of the American Association of Critical Care Nurses was a = 0.83.  Version Four was tested on a purposive national sample of 106 critical care nurses with an a = 0.88.  The reliability of Version Five of the BKAT was a = 0.84, measured on 528 critical care nurses from 24 states throughout the USA and in the District of Columbia, and was a = 0.91 for l54 non-USA critical care nurses from six different countries.   Years of experience of critical care nurses who have taken one of the BKATs has ranged from zero to >34 years.  The reliability of the BKAT, Version Six was a = 0.80, measured on 101 critical care nurses from seven states in the USA. 

            The reliability of the BKAT, Version Seven ranged from a 0.88 to 0.90, measured on 298 critical care nurses from 26 different states in the USA.  These states were Arizona, Arkansas, California, Delaware, Florida, Illinois, Indiana, Louisiana, Maryland, Massachusetts, Mississippi, Missouri, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.  All subjects were experienced RNs.  Length of experience in the ICU ranged from 6 months to >25 years. Scores ranged from 44 to 98 points, with a M=83.0 points and a standard deviation of 9.6 points.

            Minor revisions were made following the reliability testing.  Item analysis was used to guide these revisions.  One item was deleted and replaced by an item that had been previously on all versions of the BKATs for adult ICU.  In addition, minor changes were made in 5 stems, 8 distractors, and 1 answer.  This was done to improve clarity of the corresponding items. 

Uses of the BKAT

            The BKAT can be used prior to orientation classes in critical care nursing to identify needed 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 teaching methods for orientation classes, and as a means to identify content for in-service education programs for currently employed critical care nurses.  In addition, it has been successfully used in nursing research and for advanced placement of nurses with prior experience in critical care nursing, so that they do not have to attend classes which present content that 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.

 Passing Score

            No one is expected to achieve 100% (although four now have).  Rather, it is expected that following orientation, critical care nurses will achieve an average score of approximately 82-84 points on the BKAT-7.  Whether or not an average score is considered to be a passing grade depends upon which specific questions are missed; for example, being able to recognize the ECG pattern of ventricular fibrillation is critical to know in any unit.  Since the BKAT 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 BKAT.

Requests for Copies of the BKAT

Panel of Experts for the BKAT-7

The Panel of Experts for the BKAT-7 includes the following critical care nurses: 

Sue Hurst, RN, MSN, CCRN, CNRN, Arizona Marge Priestly, RN, MSN, CCRN, Colorado Karen George, RN, BSN, CCRN, Tennessee Jill Barrow, RN, MSN, Texas Carol Boswell, RN, MSN, CCRN, Virginia Beth Torres, RN, BSN, MEd, CCRN, Virginia

Data Collectors for BKAT-7

Data collectors for the BKAT-7 include the following:

Karen Anderson, RN, BSN, CCRN, Arizona Theresa Annis, RN, MS, CCNS, Wisconsin Kathy Arnold, RN, BS, MS, CNA, Illinois Lorna Baker, RN, MSN, CCRN, OCN, Florida Toni Balistrieri, RN, MSN, CCNS, Wisconsin Patricia Bradshaw, RN, MS, CEN, CCRN, CCNS, Texas Katie Brick, RN, MSN, CCNS, PCCN, CCRN, Indiana Claudette Brochu, RN, CCRN, New York Glenda J Brown, RN, MSN, Tennessee Diana Butorac, RN, MSN, Tennessee Bridget Carver, RN, BSN, CCRN, Maryland Christy Calhoun-Miller, RN, BSN, CCNR, CNRN, Missouri Karen Conway, RN, BSN, New York Michelle Ernzen, RN, MSN, CCRN, North Carolina Merri Frank, RN, MSN, CCRN,Ohio Raeann Fuller, RN, CCRN, Illinois Karen George, RN, BSN, CCRN, Tennessee Rhonda Grose, RN, CCRN, South Carolina Cathy Groseclose, RN, MS, CEN, Oklahoma Phil Hargreaves, RN, BSN, North Carolina Sheryl Hasper, RN, BSN, CCRN, Arizona Barbara Hauser, RN, MSN, Ohio Cheryl Howard, RN, MS, COHN-S, Florida Justine Kellar, RN, BSN, Maryland Deborah Klein, RN, MSN, CCRN, CS, Ohio Ardelle Kleinsasser, RN, BC, MS, South Dakota Nelda Logan, RN, C, BSN, Texas Amy Luckowski, RN, MSN, CCRN, Pennsylvania Crystal Milner, RN, FNP, CCRN, Texas Teresa Montoya, RN, CCRN, Washington Linda Morris, RN, PHD, APN, CCNS, Illinois JoAnn Panno, MSN, RN-BC, CNS, Ohio Elizabeth Rerisi, RN, BSN, CCRN, New York Peggy Riley, RN, Oklahoma Denise Rouse-Meekins, RN, MSN, CNS, Maryland Shelly Richardson, RN, Critical Care Educator, Florida Catherine Salvato, RN, MSN, CNAA, Delaware Steven Savant, RN, BSN, CCRN, Louisiana Julie Shea, RN, MSN, South Carolina Donna Sinclair, RN, MHA, Massachusetts Danita Small, RN, BSN, CCRN, California Nancy Sosa, RN, BSN, CCRN, North Carolina Jennifer Stankowski, RN, ADN, Wisconsin Chris Taylor, RN, BSN, CCRN, North Carolina Rosemary Timmerman, RN, BSN,CCRN-CSC Arkansas Beth Torres, RN, BSN, M Ed, CCRN, Virginia Iva Nell Vaughn, RN, MSN, FNP, Mississippi Mindy Walden, RN, BSN,Wyoming Marcella Will, RN, MSN, West Virginia Sharon Wolf, RN, BSN, CNOR, Virginia

 

Authors of the BKAT

Other BKATs Available

BKAT-7Sfor Telemetry/Progressive Care (2007)
PEDS-BKAT5r for Pediatric ICU (2006)
NICU-BKAT3 for Neonatal ICU (2004)
ED-BKAT for the Emergency Department (2006)

Selected References

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

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

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.

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

Smith-Blair N, Neighbors M.  Use of the Critical Thinking Disposition Inventory in critical care orientation. J Cont Educ Nurs.  2000;31(6):251-256.

Toth JC.  Follow-up Survey 10 years later:  Use of the Basic Knowledge Assessment Tools (BKATs) for critical care nursing and effects 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 (submitted for review July 15, 2005).

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.

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