The Basic Knowledge Assessment Tool
For Neonatal Intensive Care Nursing, Version Three
(NICU-BKAT3)
2004
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 which 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 the BKAT 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 NICU- BKAT
The NICU-BKAT3 is a 75 item paper and pencil test that measures basic knowledge in neonatal intensive care nursing. These items measure content related to the following areas of critical care nursing practice: cardiovascular, pulmonary, gastrointestinal/parenteral, renal, neurology, monitoring lines/catheters, family/spiritual care, and other. The category ‘other’ includes such areas as developmental care, sleep, and blood incompatibilities.
The NICU-BKAT3 takes approximately 45 minutes to complete . The total possible score is 75 points. Items on the test 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 NICU nursing practice are integrated into specific questions in the NICU-BKAT3.
Validity
Content for the initial version of the NICU-BKAT called the NICU-BKAT1 was taken from the PEDS-BKAT. It had 85 items; 47 PEDS-BKAT items were modified for use in the NICU-BKAT1 and 38 new items were added. These were identified through a review of the literature and through the suggestions from a five member Panel of Experts in neonatal intensive care nursing practice and education. Validity for the NICU-BKAT1 was established through the Panel of Experts and through comments by nurses working in NICUs during reliability testing. The NICU-BKAT1 has been revised twice and is now the NICU-BKAT3 (Version Three).
Reliability and Average Scores
Cronbach’s Coefficient Alpha (a) was used as the measure of internal consistency for all versions. The reliability of the NICU-BKAT1 is a = 0.81, measured on 60 neonatal intensive care nurses from nine different states in the USA. Scores ranged from 34 to 80 points, with a M= 55.6 points (65.4% correct answers) and a standard deviation (SD) of 8.4 points. Since the mean score was low, the test was revised to improve clarity. Five items were deleted. This was guided by item anaylsis and comments from the NICU RNs who took the test.
The NICU-BKAT2 became an 80 item test. Reliability was computed on a second sample of 68 NICU RNs from 6 different states. Scores ranged from 34 to 72 with M=58.5 (73.2% correct answers), and a SD = 7.6. Although the internal consistency was alpha = 0.80, the mean score remained low, indicating that the test was still too difficult. Therefore, the Panel of Experts was contacted again (2 former members and 1 new member). Ten (10) items were deleted and 11 new items were written. New items paid more attention to the psychosocial/spiritual components of basic knowledge in NICU nursing, than previously. This resulted in the NICU-BKAT3.
Reliability testing on the NICU-BKAT3 was conducted on 53 NICU RNs working in the following 6 states: Arkansas, Florida, Georgia, Illinois, Tennessee, and Texas. Six questions were deleted following data collection on the 81 item scale and wording was changed in 12 items to improve clarity, resulting in the 75 item questionnaire. Scores ranged from 46 to 70 out of a possible 75 points. The average score was 59.3 points (79.0% correct answers), SD = 6.1 points. The internal consistency reliability is 0.76 (Cronbach's alpha).
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 advance placement of nurses with prior experience in critical care nursing, so that they do not have to attend classes that 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 Ó and may not be altered, added to, or used in part. Permission must be obtained to use the BKAT.
Passing Score
No one is expected to achieve 100%. Rather, it is expected that following orientation, neonatal intensive care nurses will achieve an average score of 78% to 80% correct answers on the NICU-BKAT3. 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 respiratory distress is critical to know in any unit. As BKATs are being used in a wide variety of clinical settings, which questions are essential to know for that setting is decided by the nurse administering the BKAT.
Requests for Copies of the NICU- BKAT
Contact Dr Jean C Toth, RN, (toth@cua.edu).
Panel of Experts for the NICU-BKAT
The Panel of Experts for the NICU-BKAT includes the following critical care nurses:
Janice Alford, RNC, LCCE, IBCLC, North Carolina
Allison McCormick Greenleaf, RN, BSN, Virginia
Kathleen Buckley RN, PhD, Washington, DC
Maria Gallo, RN, MSN, Virginia
Amy Johnson, RN, DNSc, Delaware
Kimberly Moore, RNC, BSN, Alaska
Data Collectors for NICU-BKAT
Data collectors for the NICU-BKAT include the following:
Sandra Bennett, RN, BSN, Arkansas
Diane Boyle, RN, MBA, Illinois
Eve Butler, RN, MSN, CCRN, CNS, Florida
Victoria DeCastro, RNC, BSN, Ohio
Lynne Clark, RN, BS, CCRN, CPAN, Georgia
Darlene Drake, RN, Georgia
Janet Figueroa, RN, Texas
Penny Fuller, RN, MSN, PNP, Virginia
Zola Golub, RN, New York
Frances Iacobellis, RN, MSN, CCRN, New York
Barbara Labuda, RNC, MSN, Illinois
Vicki Lekas, RN, MSN, California
Nelda Logan, RN, C, BSN, Texas
Felicia Lombardo, RN, MSN, Pennsylvania
Janna Martin, RN, MSN, North Carolina
Patricia Maloney, RNC, MS, CNS, Massachusetts
Sherry McKee, RN, BSN, CCE, Pennsylvania
Pamela McMillian, RNC, MS, Arkansas
Teresa Mingrone, RN, BSN, Pennsylvania
Eileen Murray, RN, Georgia
Neta Parkman, RN, CCRN, CNRN, Mississippi
Ginger Pesata, RN, MSN, Florida
Sandra Reece, RN, CS, MSN, New York
Lori Rubarth, RN, NNP, PhDc, Arizona
Schmidt, Carmen, RN, MSN, New York
Mary Settle, RNC, MS, NNP, Texas
Jean Sosin, RN, Illinois
Georgita Washington, RN, MSN, CCRN, CCNS, Tennessee
Rosemary Westra, RN, MS, Massachusetts
Leonora Yaun, RN, New York
Kit Yuen, RN, New York
Authors of the BKAT
The initial version of the BKAT(BKAT1) was co-authored by Jean C Toth, RN, CNS, BC, PhD, The Catholic University of America, Washington, DC and by Kathleen Ritchey, RN, CNS, MSN, formerly of the Veterans Administration Medical Center, Washington, DC. All subsequent BKATs and their versions were authored by Dr. Toth.
Other BKATs Available
BKAT-7 for Adult Critical Care (2006)
BKAT-7S for Telemetry/Progressive Care (2007)
PEDS-BKAT5 for Pediatric Intensive Care Unit (PICU)
ED-BKAT for the Emergency Department (2006)
Selected References
Frisch SR. Evaluating the collaborative critical care nursing program. Canadian J Nurs Res;21(1):5-17.
McConnell EA, Fletcher J, Nissen JH. A comparison of Australian and American registered nurses’ use of life-sustaining medical devices in critical care and high-dependency units. Heart Lung. 1993;22(5):421-427.
Oermann MH. Effectiveness of a critical care nursing course: Preparing students for practice in critical care. Heart Lung. 1991;20(3):278-283
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. 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. Comparing basic knowledge in critical care nursing between nurses from the United States and nurses from other countries. American Journal of Critical Care. 2003;12(1):41-46.
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, In Press).
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, 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.
Last Revised 28-Feb-08 04:03 PM.
