The Basic Knowledge Assessment Tool, Version Ten, 
(BKAT-10r)
For Adult Critical Care Nursing 
(Version Ten, 2022)

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 hospitalized in Critical Care Units. 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 42 years, it has become accepted as one standard for measuring basic knowledge in critical care nursing. To date, over 24.315 copies of a BKAT have been sent out to critical care and medical/surgical nurse educators and managers in the USA and in other English speaking countries.  

BKAT-10r

            The most recent version of the adult BKAT for ICU is Version Ten (2022). It is an 84-item paper and pencil test that measures basic knowledge in critical care nursing. These items measure content related to the following 8 areas of critical care nursing practice: Cardiovascular, pulmonary, monitoring lines, neurology, endocrine, renal, gastrointestinal/parenteral, and other. The category ‘other’ includes such areas as infection control, hypothermia, burns, and spiritual care.

            The BKAT takes approximately 45 minutes to complete; it should be supervised during test-taking. The total possible score is 84 points (100%). Items on the BKAT 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 critical care nursing practice are integrated into specific questions in the BKAT.

Validity

             Content for the initial version of the BKAT-1 (1979) was identified through clinical experience, 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 for each of the subsequent versions of the BKAT was established through Panels of Experts. Validity has also been supported through samples of baccalaureate nursing students, new graduate nurses, and foreign nurses (not working in the USA) have been used as groups known to be different from practicing critical care USA nurses.  

            The BKAT-10 was based on the BKAT-9. A four-member Panel of Experts was used in this update of the BKAT-9r. It is noted that basic knowledge in critical care nursing does not change quickly. Most changes are customarily related to new medications and equipment used.  

Reliability of Previous Versions of the BKAT

            Cronbach’s Coefficient Alpha () has been used as the measure of internal consistency for all versions of the BKAT. Previous Alpha reliabilities have been quite acceptable with scores in the range of Alpha scores of 80 – 90.  

            BKAT-10r scores of critical care RNs who have participated in reliability testing so far have ranged from 79.8% to 89.5% correct answers with an average score of 85.3%. This is quite similar to previous testing of earlier versions of the BKAT.  

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.  

            The BKAT is copyrighted  and may not be given to to another RN for any reason, whatsoever, nor altered, added to, or used in part. Permission must be obtained to use the BKAT. No BKAT may be placed on any computer for any reason.

Passing Score

            No one is expected to achieve 100% (although several now have). Rather, it is expected that following orientation, critical care nurses will achieve an average score, as established during reliability testing of the BKAT-10r, or 80-90% correct answers.

Requests for Copies of the BKAT-10r

            The BKAT-10r is being provided at our cost, to nurses who work in critical care, as a service to nursing and to the ministry that nursing represents. A payment of $25.00/BKAT ordered (up to 4 BKATs only). This is requested to cover photocopying, postage, handling, and continued updating and validity and reliability testing. Permission to use the BKAT-10r and to photocopy it for your sole use can be obtained by writing to Jean C Toth, PhD, RN, MSN, CV-CNS, BCCC, 

                                 The Mailing address is :

BKAT
P. O. Box 6295
Washington, DC 20015

        Additional information related to what BKATs are available and what research is currently being conducted can be found on the BKAT Webpage at 

www.BKAT-toth.org



Panels of Experts for the BKAT-10r  

     The BKAT-10r is based on the BKAT-9r. A four member Panel of Experts with professional nursing was used to validate/update questions.  

     Changes made from the BKAT-9r included the deletion of 1 question, the re-writing of 5 questions, and the change of 10 distractors. These changes were made so that the BKAT-10r would be a better reflection of current knowledge and practice, have improved discrimination ability, and better reflect current practice and current medications used in the ICU. . .

The Panel of Experts, for the BKAT-10r included the following nurses:

Christine Hugh, RN.MSN, CCRN-K Miami. Florida
Katheryn Davies, RN, DHA, ACNS-B, Orlando, FL
Jean Toth, RN, PhD, BCCC, Washington, DC
Kathleen Galichio, RN, MS, ACNS-BC, CCRN, WCC, 
Albany, NY (Volunteer)

Participants in the Evaluation of the BKAT-9r for use in the BKAT-10r included: 

Samantha Leontie, RN, MSN, CNL, CCRN, Bridgeport, VA  
Whitney Johnson Krauss, RN, BSN, Rockingham, VA  
Georgia Magnussen, RN, MSN, CCRN, Virginia Beach, VA  

Authors of the BKAT

     The initial version of the BKAT (BKAT-1) was co-authored by Jean C Toth, PhD, RN, MSN, 
CV-CNS, BCCC, Washington, DC, and Kathleen Ritchey, RN, MSN, CV-CNS, formerly of the Veterans Administration Medical Center, Washington, DC. All subsequent BKATs have been authored by 
Dr Toth. 

Other BKATs Available (in addition to the BKAT-10r)

       Critical Care:

   BKAT-9S for Telemetry/Progressive Care (2015)
   PICU-BKAT6 for Pediatric ICU (2014)
   NICU-BKAT5r for Neonatal ICU (2009) 
   ED-BKAT3r for Emergency Department (2020)
   PEDS-ED for Pediatric Emergency Department (2011)
   BKAT-CC for Contagion Control (2020)

        Non Critical Care:

   MED-SURG2 (2018)  
   BKAT-CC for Contagion Control (2020), {also}


Selected References Over the Years

         Scarboro , M. & McQuillan, K. A.. Traumatic brain injury update. AACN Advanced Critical Care. Spring, 2021, 29-50.

         Patel, V. N. & Stone, S. D. Patients with advanced caner requiring intensive care: Reasons for ICU admission, mortality outcomes, and the role of palliative care. AACN Advanced Critical Care. Fall, 2021, 324-331.

        Morata, L., Sole., M. Guido-Sanz, F., Ogilvie, C. & Rich, R. Manual vs automatic prone positioning, and patient outcomes in acute respiratory distress syndrome. AJCC, American Journal of Critical Care. 2021, 30:2, 104-112.

        Scarboro, M. & McQuillan, K. A. Traumatic brain injury update. AACN Advanced Critical Care. Spring, 2021, 29-50.

        Edward, Galletti, A. & Huynh, M. Enhancing communication with family enbers in the intensive care unit. Critical Care Nurse. 2020, V.40, 23-31.

        Simmons, A. M., Rivers, F.M., Gordon, S. & Yoder, L. H. The role of spirituality among military en-route care nurses; Source of strength or moral injury? 2018, 38, 2, 61-67.  

        Toth, J.C. The participation of emergency nurses in the development of the Basic Knowledge Assessment Tool (BKAT) for the emergency department, the ED-BKAT2. Journal of Emergency Nursing. 2013;30(3),238-244. 

        Alspach, J. Editorial: Weighing the evidence on patient safety strategies to implement now. Critical Care Nurse. 2013; 33(3), 9-12

        Lakanmaa, R, Suominen, T, Perttila, J, Puukka, P, & Leino-Kilpi, H. Competence requirements in intensive and critical care nursing - Still in need of definition? A Delphi study. Intensive and Critical Care Nursing. 2012; 28, 329-336.

        Burchell, P.L, & Powers, KA. Focus on central venous pressure monitoring in an acute care setting. Nursing, 2011; December, 39-43.

        LaPointe, N.M., Sun, J. & Kaplan, S. In-hospital management of patients with atrial flutter. American Heart Journal. 2010; 159(3), 370-376.

        Jacobs, I., Sunde, K., Deakin, C.D. et al. Part 6: Defibrillation 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation: American Heart Association. 2010; 122 (Supp. l2), S325-S337.

        Peate, I. Caring for the patient with angina: Causes and treatment. British Journal of Healthcare Association. 2010; 5 (03), 65-69.

        Nottingham, F. Diagnosis and treatment of atrial fibrillation in the acute care setting. Journal of the American Academy of Nurse Practitioners. 2010; 22, 280-287.

        Donough, M. Clinical updates: Treating ventricular tachycardia. The Journal of Continuing Education in Nursing. 2009; 40(8), 342-343.

        Helms, S, Carkhuff, M, Simmons, M. & Sutton, G. concerted team effort: A multidisciplinary strategy is needed to conquer VAP. Advance for Nurses. 2009; 11(1), 15-16.

       Stravroudis, T.A., Miller, M.R. & Lehmann, C.U. Medication errors in neonates. Clinics in Perinatology. 2008; 35, 141-161.

         Morris, L.L. et al. Designing a comprehensive model for critical care orientation. Critical Care Nurse. 2007; 27(6): 37-60.

        Toth J.C. 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): 342-348.

        Toth J.C. 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.

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

        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.

        Messmer P.R, 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.

        Moore, K.A, Coker, K, Swett, B, & Edwards, WH. Implementing potentially better practices for improving family-centered care in neonatal intensive care units: Successes and challenges. Pediatrics. 2003;111(4),450-460.

        Toth J.C. 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.

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

        Toth, J.C, 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):98-105.

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

JT 01/05/22