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 22 years, it has become accepted as one standard for measuring basic knowledge in critical care nursing. To date, over 6,000 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 21 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).
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 75.2 points (78.3%) 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 Ó 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
The PEDS-BKAT5 is being provided at cost to nurses who work in critical care as a service to nursing and to the ministry that nursing represents. A payment of $12.50 is requested to cover photocopying, postage, handling, the BKAT Research Award, and continued validity and reliability testing. Permission to use the PEDS- BKAT5 and to photocopy it can be obtained by writing to Jean C Toth, RN, PhD, The Catholic University of America, Washington, DC 20064 (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
Joanne Coleman, RN, MSN, Mississippi
Charlene Cunningham, RN, MSN, CCRN, Georgia
Rachel Dalgleish, 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
Each version of the BKAT was coauthored by:
Jean C Toth, RN, CNS, BC, MSN, PhD
The Catholic University of America
Washington, DC 20064
toth@cua.cua
Kathleen Ritchey, RN, CNS, MSN
Formerly of the Veterans Affairs Medical Center
Washington, DC 20422
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)
NICU-BKAT3 for Neonatal ICU (2004)
ED-BKAT for the Emergency Department (2006)
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