The Basic Knowledge Assessment Tool , (BKAT-9S)
For Telemetry/Progressive Care Nursing
Version Nine (9S), 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 in Telemetry/Progressive Care. 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 36 years, it has become accepted as one standard for measuring basic knowledge in critical care nursing.
To date, over 23,000 copies of a BKAT have been sent out to critical care nurse educators and managers in the USA, who have requested a copy of the BKAT to photocopy for use in the professional practice. Research continues to be conducted and published on the development and use of the BKAT. Although BKATs have been used in foreign countries in the past, support for their use outside the USA or Canada has not been forthcoming.
There are currently seven (7) different BKATs. These are BKAT-9r for Adult ICU, BKAT-9S for Telemetry/Progressive Care, ED-BKAT3r, PICU-BKAT6r, NICU-BKAT5r, and MED-SURG BKAT2 . See the BKAT Webpage for additional information at www.BKAT-toth.org
The most recent version of the adult Telemetry/Progressive Care BKAT is Version Nine (2015). It is a 76 item paper and pencil test that measures basic knowledge. These items measure content related to the following areas of critical care nursing practice:
The following revisions were made in response to item analyses of the BKAT-9r for Adult ICU, and clinical judgment: The 10 items with the word, ‘Except’, were reworded to remove the word ‘Except’, 3 question stems were reworded and 44 distractors were reworded to improve clarity and update to current nursing/medical practice. In addition, 2 new items were added and 6 items were deleted as they no longer represent current practice, and 5 answers were revised to enhance accuracy. The resulting BKAT-9S takes approximately 40 minutes to complete. The total possible score is 76 points. Items on the BKAT-9S 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-9S .
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 for each of the nine versions of the BKAT 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. The original BKAT for Telemetry/Progressive Care was the BKAT-4S, named after the BKAT-4 for adult ICU. The ‘S’ stands for ‘short version’.
Construct validity. The construct, basic knowledge in Telemetry/Progressive Care, was measured on all versions of the Telemetry/Progressive Care BKAT.
Most recently, construct validity of the BKAT-9S was measured during reliability testing through the technique of known group differences. RNs with > one year experience working in Telemetry/ Progressive Care (n=35) were compared using a t-test for independent groups, to new graduate nurses (n=9)--a group known to be different--with < one year experience in nursing. The years working in Telemetry/Progressive care for the experienced RNs ranged from zero to 32 years, with a mean of 8.2 [Mdn=5.0] years and a standard deviation of 9.3 years. Basic knowledge in Telemetry/Progressive care results were statistically different with the experienced RNs scoring higher than the new graduate nurses: t (42) = 4.1, p < .0005 [one tail], Sign.
Also, the correlation of years of experience in Telemetry/Progressive Care with scores was statistically significant: r(29)=0.63, p<.0005, [one tail], Sign. This supports previous findings with other BKATs that as the number of years increases, so does basic knowledge.
In addition, in this study, support for the construct validity of the BKAT-9S was measured between experienced Telemetry/Progressive Care RNs (N=35) and ICU RNs (N=34). Surprisingly, there was no difference between the two groups, t (77) = 1.3, NS. This may be due to the recent increase in severity of illness of patients seen in Telemetry/Progressive Care and/or an increase in-service educational programs there. The Telemetry/Progressive Care nurses studied came from the following 10 states: Arizona, Colorado, Florida, Kansas, Kentucky, Louisiana, Missouri, Montana, New Mexico, and Washington.
Reliability and Average Scores on the BKAT-9S
Reliability. Cronbach’s Coefficient Alpha () has been used as the measure of internal consistency for all previous versions of the Telemetry/Progressive Care BKAT, and ranged from () 0.77 to 0.85. Reliability in the BKAT-9S study ranged from () 0.78 to 0.87. The average score. Scores on the BKAT-9S for Telemetry/Progressive Care, ranged from 61% to 95% correct answers. The average score on the BKAT-9S was 81% correct answers.
No one is expected to achieve 100%. Rather, it is expected that following orientation, Telemetry/Progressive Care nurses will achieve an average score of 80% - 81% on the BKAT-9S. 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-9S.
Uses of the BKAT
The BKAT-9S 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 Telemetry/ Progressive 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 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, placement, hiring, or firing situations. It is copyrighted and may not be altered, added to, or used in part. Permission must be obtained to use and make copies of any BKAT. No BKAT may be placed on any computer for any reason.
Requests for Copies of the BKAT-9S
To request a copy of the BKAT-9S go to the BKAT webpage at www.BKAT-toth.org and click on the yellow bar to the left marked, “To Order”. Additional information related to what BKATs are available and what research is currently being conducted can be found on the BKAT Webpage, www.BKAT-toth.org.
The BKAT-9S 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 is requested to cover photocopying, postage, handling, and continued updating and validity and reliability testing. Permission to use the BKAT-9S and to photocopy it can be obtained by writing to J. Toth, PhD, RN, MSN, CV-CNS, BCCC, PO Box 6295, Washington, DC 20015.
Data Collectors for BKAT-9S include the following:
Natalie Boucher, MSN, RN-BC, CMS-RN, Montana
Kathy Bunzil, MS, RN, CCNS, ACNS-BC, ACHPN, Colorado
Cheryl Couch, BSN, RN, CCRN, Missouri
Shannon Davis, MSN-Ed, RN, PCCN, Arizona
Callie Gollihue, MSN, RN, CCRN, Kentucky
Kistan Gunn, MSN, RN, CCRN-K, Washington
Julie Heitman, MSN, RN, Kansas
Sarah Kemper, MSN, RN, CNL, Florida
Todd Marlow, BSN, RN, Florida
Diane Muzenjak, MSN, CCRN, APRN-BC, CNS, New Mexico
Kathy Nickel, MSN, RN-BC, Arizona
Mary Potter, MS, RN, ACNS-BC, CCNS, CCRN, Colorado
Katheryn Richard, BSN, RN, Louisiana
Authors of the BKAT
The initial version of the BKAT was coauthored by:
J. Toth, RN, CV-CNS, MSN, PhD, BCCC
P. O. Box 6295
Washington, DC 20015
K. Ritchey, RN, CNS, MSN
Formerly of the Veterans Affairs Medical Center
Washington, DC 20422
Each subsequent BKAT and Versions of the BKATs were authored by Dr J. Toth, RN, Washington, DC, 20015.
Other BKATs Available
BKAT-9 r for Adult Critical Care (2015) PICU-BKAT6 r for Pediatric ICU (2014) NICU-BKAT5r for Neonatal ICU (2016) ED-BKAT3r for the Emergency Department (2020) PEDS-ED BKAT for the Pediatric Emergency Department (2011) [in revision] MED-SURG BKAT2 for Medical/Surgical Nursing (2018)
AACN Bold Voices. ‘Stop Sepsis’ Program reduces mortality rate 40%. 2014;6(4),9.
AACN Bold Voices. C Diff. 2014;6(1),10, as reported on-line, in The Journal of the American Medical Association.
AACN Bold Voices. Gloves and gowns may reduce MRSA infection in ICUs. 2014;6(1),10.
Toth, JC. 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.
Toth, J C. (2011). Development of the Basic Knowledge Assessment Tool for Medical-Surgical Nursing (MED-SURG BKAT) and Implications for In-Service Educators and Managers. Nursing Forum, 46(2), 110-115.
Alspach, J. Editorial: Weighing the evidence on patient safety strategies to implement now. Critical Care Nurse. 2013;33(3), 9-12
Advance for Nurses. C Diff. 2013;15(10),12,26.
At the Bedside. AACN Bold Voices. Older patients in ICU at high risk for HAI. 2012;4(8), 16.
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. At the Bedside. AACN Bold Voices. Safety program reduces CLABSIs by 40 percent. 2012;4(12), 9.
Practice Alert. AACN Bold Voices. Catheter-associated urinary tract infections. 2012;1(12), 13.
Burchell, PL, & Powers, KA. Focus on central venous pressure monitoring in an acute care setting. Nursing2011; December, 39-43.
Stacy, KM. Progressive care units: Different but the same. Critical Care Nurse. 2011;31(3), 77-83.
LaPointe, NM, 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, CD 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(Suppl2),S325-S337. http://circ.ahajournals.org
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.
Riddle, E, Bush, J, Tittle, M, & Dilkhush, D. Alcohol withdrawal: Development of a standing order set. Critical Care Nurse. 2010;30(3),38-45.
McDonough, 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.
Dill, B. Critical Care, food for thought. Advance for Nurses. 2008; 10(26)15.
Stravroudis, TA, Miller, MR, & Lehmann, CU. Medication errors in neonates. Clinics in Perinatology. 2008;35,141-161.
Morris, LL et al. Designing a comprehensive model for critical care orientation. Critical Care Nurse. 2007;27(6): 37-60.
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;21(4): 342-348.
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.
Herdrick B, Lindsay A. Nurse residency programs. Journal for Nurses in Staff Development. 2006;March/April:55-62.
Collins ML, Thomas TL. Creation of a stepdown nurse internship program. Journal for Nurses in Staff Development. 2005;May/June:115-119.
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.
Lam, BCC, Lee, J, & Lau, YL. Hand hygiene practices in a neonatal intensive care unit: A multimodal intervention and impact on nosocomial infection. Pediatrics. 2004;114(5),565-571.
Messmer PR, 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, KA, Coker, K, Swett, B, & Edwards, WH. Implementing potentially better practices for imkproving family-centered care in neonatal intensive care units: Successes and challenges. Pediatrics. 2003;111(4),450-460.
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, 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 JC, Ritchey KA. New from nursing research: The Basic Knowledge Assessment Tool (BKAT) for critical care nursing. Heart Lung. 1984;13(3):271-279. [Initial publication on BKAT]