The Basic Knowledge Assessment Tool , (BKAT-9r) ©
For Adult Critical Care Nursing
(Version Nine, 2015)
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 34 years, it has become accepted as one standard for measuring basic knowledge in critical care nursing.
To date, over 19,000 copies of a BKAT have been sent out to critical care nurse educators and nurse managers in the USA, who have requested a copy of the BKAT to photocopy for use in their practice. Research continues to be conducted and published. However, research support for the use of the BKATs outside the USA or Canada has not been forthcoming.
There are currently seven (7) different BKATs. These are BKAT-9r for Adult ICU, BKAT-8S for Telemetry/Progressive Care, ED-BKAT2, PICU-BKAT6r, NICU-BKAT4, and MED-SURG BKAT. These are described individually on this WebSite.
The most recent version of the adult BKAT is Version Nine (2015). It is a 85-item paper and pencil test that measures basic knowledge in critical care nursing. These items measure content related to the following 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 and has been administered on a supervised and unsupervised basis with no statistical difference in scores. The total possible score is 85 points (100%). .
Content for the initial version of the BKAT or BKAT-1 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 BKATs (2-8) was established through a panel of experts. Validity 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. 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 USA critical care nurses. The mean (M) BKAT scores of the students, new graduates, and foreign nurses; were, as expected, significantly lower than the M scores of the ICU nurses.
Panel of Experts. The BKAT-9r was based on the BKAT-8. A 10-member Panel of Experts, professional experience, and review of evidence in the literature were used to validate/update questions. These revisions included the deletion of 7 questions--with either low item to total correlations or outdated material--and the addition of two questions. Revisions were also made to 10 stems, 8 answers, and 46 distractors.
Construct validity of the BKAT-9r to measure known group differences between experienced ICU RNs and new graduate nurses showed a statistical difference between the groups [t(174)=2.7, p <.005], with experienced nurses scoring higher.
Reliability for the eight previous versions of the BKAT for Adult ICU ranged from an alpha of 0.78 to 0.90, on sample sizes from 74 to 528. Reliability for the BKAT-9r is alpha 0.84 obtained on a sample of 176 nurses working in an ICU. This is described below.
A sample of 176 ICU RNs from the following 11 states participated in reliability testing: Arizona, Georgia, Illinois, Kentucky, Mississippi, New Hampshire, New Mexico, North Carolina, Ohio, Nevada, and Texas. All worked in the adult ICU. The units were ICU (45%), ICU-CCU (20%), MICU (5%), SICU (3%), and combination units (27%). Jobs included staff nurses (81%), managers/supervisors (8%), educators, (7%), and clinical specialists (3%).
Uses of the BKAT
The BKAT can be used in the following ways:
- to identify content for orientation classes,
- as a pretest and/or a posttest to measure learning in groups of nurses,
- as a dependent variable to test different teaching methods for orientation classes,
- to identify content for in-service education programs for currently employed critical care, &
- for advanced placement of nurses with prior experience in critical care nursing,
The BKAT is only one measure of basic knowledge in critical care nursing; it 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, and to make copies of it. No BKAT may be put on any computer for any reason: This is not negotiable.
No one is expected to achieve 100% . Rather, it is expected that following orientation, critical care nurses will achieve an average score on the BKAT-9r of 82-84% correct answers.
Requests for Copies of the BKAT-9r
The BKAT 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 $15.00 is requested to cover photocopying, postage, handling, and continued updating and validity and reliability testing. Permission to use the BKAT-9r and to photocopy it can be obtained by writing to Jean C Toth, PhD, RN, MSN, CNS, BCCC, PO Box 6295, Washington, DC 20015, or sending an email to BKAT7.email@example.com. Additional information related to what BKATs are available and what research is currently being conducted can be found by going to the Homepage or clicking the 'Research' bar on this Webpage.
Panel of Experts for the BKAT-9r
The Panel of Experts included the following critical care nurses:
Catherine Riedel, MSN, RN, ACNS-BC, CCNS, CPAN, CCRN-CSC, California
Dina Elias, MSN, RN, CNS, CCRN, California
Denise Henderson, MSN, RN, Indiana
Barbara Hissong, MSN, RN, CCRN, Florida
Jean Hunt, MSN, RN, CVRN-BC, Indiana
Marcia Ilnicki, BSN, RN, CCRN, Indiana
Rebecca Lane, MSN, RN, CCRN, CEN, Indiana
Lynn Marder, MS, RN, CNS, PCCN, California
Alex Markwell, MSN, RN, MHA/MBA, CEN Florida
Beth Torres, PhD, RN, CCRN, Virginia
Data Collectors for the BKAT-9r included the following critical care nurses:
Mark Bisbee, MN, RN, CCRN, Illinois
Diane Byrum, MSN, RN, CCNS, FCCM, North Carolina
Pam Cosper, MSN, RN, NEA-BC, Georgia
Jennifer Drumm, MSN, RN, Kentucky
Julia Eberwine, MSN, RN, CCRN, PCCN-CMC, Ohio
Callie Gollahue, MSN, RN, CCRN, Kentucky
Lisa Hughes, BSN, RN, Arizona
Jean Hunt, MSN, RN, CVRN-BC, Indiana
Marcia Ilnicki, BSN, RN, CCRN, Indiana
Elizabeth Kloska-Kearney, MSN, RN, CCRN, Indiana
LCDR Eric Kulhan, MSHSA, MEd, RN-BC, BSN, Illinois
Yolanda Martin, BSN, RN, Mississippi
Julie Miller, BSN, RN, CCRN, Texas
Diane Muzenjak, MSN, CCRN, APRN-BC, CNS, New Mexico
Patricia Nietrzeba, MS, RN, Nevada
Donna Proulx, MS, RN, CCRN-CSC, New Hampshire
Mitzie Trammel, MS, RN, CCRN, North Carolina
Angela Wilson, BSN, RN, Illinois
Mary Zellinger, MN, RN, ANP-BC, CCRN-CSC, Georgia
Authors of the BKAT
The initial version of the BKAT (BKAT-1) was co-authored by Jean C Toth, RN, MSN, CNS, PhD, BCCC, The Catholic University of America, Washington, DC, and Kathleen Ritchey, RN, MSN, CNS, formerly of the Veterans Administration Medical Center, Washington, DC. All subsequent BKATs and their versions were authored by Dr Toth.
Other Critical Care BKATs Available:
BKAT-8Sr for Telemetry/Progressive Care (2009) [in research]
ED-BKAT2 for Adult Emergency Department (ED) (2012)
PICU-BKAT6 for Pediatric ICU (2014)
NICU-BKAT4 for Neonatal ICU (2009) [in research]
PEDS-ED BKAT for the Pediatric ED (2011)
MED-SURG BKAT for medical-surgical nursing (2010)
Official BKAT Website: www.BKAT-toth.org
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