The PICU-BKAT6r   © 
The Basic Knowledge Assessment Tool (BKAT) © For the Pediatric Critical Care Nursing, Version Six,
PICU-BKAT6r  (2014)


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.

History of the PICU-BKAT6r 

The PICU-BKAT began as the PEDS-BKAT4 (Version Four) that 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) = 9.8. 



Content Validity and the Panel of Experts.  The PEDS-BKAT5 is a 96 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 then new adult BKAT (Version 7, 2005), 4) use of 7 items from the BKAT for the Neonatal ICU (NICU-BKAT3, 2004), and 5) the revision of 44 items  Changes to these included changing the stems, answers and/or distractors to improve clarity and to update current practice situations described the items.  Only 14 items were not changed.


Panel of Experts

Content validity.  The PICU-BKAT, Version Six, was developed from the PEDS-BKAT5r, through a review of the literature and the work of an eleven-member Panel of Experts convened in 2011.  The Panel included seven clinical nkurse edcators--PICU, pediatrics, critical care--and a Director of Simulation and held certifications such as CCRN and PNP.  One held the PhD, and nine the Master's Degree.

All Panelists rated each question on the PEDS-BKAT5r on its basicness with '1' being most basic to t he PICU and '5' being more advanced information.  They also made comments to the correctness of the questions,l whethr content areas were current, what items should be deleted, and what topics should be added.  As a result of their work, 16 items were delted from the PEDS-BKAT5r test, and 8 new items written and added.  In addition, 18 stems and 17 distractors were changed to improve clarity and to update content.

The work of the Panel of Experts resulted in an 82 item paper and pencil test that measured basic knowledge in the PICU.  Prior to reliability testing, construct validity was done (see below).

Construct validity [that the test truly measures basic knowledge in PICU nursing knowledge] was computed on two groups known to be different in knowledge.  These two groups were experienced PICU RNs and new graduate nurses hired to work in the PICU.  The scores on the PICU-BKAT6 tests for 17 new graduates ranged from 44 points (53.7%%) out of 82 possible points to 68 points (82.9%), with a mean score of 56.8 points (69% correct answers).

Contrary-wise, the 59 experienced PICU RNs with 1 to 36 years of PICU experience ranged from 42 points (51.2%) to 82 (100%), with a mean of 64.7 points (79%).  These two groups were statistically different, with the experienced PICU nurses scoring significantly higher than the new grads [t(74)=3.6, p<.0005].  Thus, evidence exists that the PICU-BKAT6 discriminated basic knowledge in PICU nursing between new grads and experienced PICU RNs or supports the validity of the PICU-BKAT6 in measuring basic knowledge in PICU nursing.

Reliability Testing

Testing of the internal consistency reliability was done on samples from 91 to 120 RNs currentloy working in a PICU, and was alpha = 0.81 to 0.83  

Revsions done after reliability testing  included the deletion of 6 items, and changes in one stem, 6 answers, and 19 distractors.  Revisons resulted in a 75 item test, called the  PICU-BKAT6r.

Content Areas

The content areas includes:

· Cardiovascular, 19 items (cardiac output, EKG interpretation, 
                  electrical/emergency situations, drugs), · Monitoring lines, 5 items (arterial, CVP),· Pulmonary, 10 items (ventilators, pulmonary assessment/care),· Neurology, 8 items (assessment/care, drugs),· Endocrine, 8 items (diabetes mellitus, drugs, stress),· Renal, 7 items (assessment/care, peritoneal dialysis/CVVH),· GI/parenteral, 5 items (nutrition, GI bleeding), and· Other, 20 items (as abuse, children’s play, drug OD and calculation, family/spiritual care,
                    and trauma).

Uses of the PICU-BKAT6r

The BKAT can be used during orientation classes in the PICU 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 PICU nurses.  In addition, it has been successfully used for advanced 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 and may not be 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

The recommended passing score is 79%.  

 The PICU-BKAT6r takes approximately 40 minutes to complete.  The total possible score is 75 points.  Items on the PICU-BKAT6r 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 PICU-BKAT6r.

No one is expected to achieve 100%.  Rather, it is expected that following orientation, PICU nurses will achieve an average score of approximately 79% 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 PICU-BKAT6r 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 PICU-BKAT6r.

PICU RNs who Participated in the Development of the PICU-BKAT6r

Panel of Experts 

The Panel of Experts for the PICU-BKAT6r include the following critical care nurses:

Katherine Arroyo, MSN, RN, APN, CCRN, PCNS-BC, Indiana
Shelly Buhl Roth, MSN, RN, South Dakota
Heather Casper-McLay, MS, RN, South Dakota
Jennifer Chaikibn, MSN/MHA, RN-BC, CCRN, Washington, DC
Pat Fischer, MSN, RN, Virginia
Maureen LaTour, MSN, RN, CNL, Florida
Kelly Keefe-Marcoux, MSN, CPNP-AC, CCRN, New Jersey
Marilyn Maddox, MSN, RN-BC, CCRN, Missouri
Cindy McCauley, RN-BC, CLC, Colorado
Beth Torres, PhD, RN, CCRN, Virginia
Lisa Varenhorst, MSN, RN, South Dakota

Data Collectors

Data collectors for the PICU-BKAT6r include the following critical care nurses:

Corazon Barbon, MSN, RN-BC, APRN-BC, CCRN, New Jersey
Stephanie Becherer, MSN, RN, CCNS, Florida
Jean Carraher, MSN, RN-BC, CCRN, Minnesota
Jill Crawfored, MSN, RN, NE-BC, Illinois
Catherine Geisen, AND, RN, CRN, Illinois
Alicia Kleinhans, BSN, RN, CCRN, CEN, C-NPT, Florida
Alicia Layman Heillman, MSN, RN, Texas
Jamie McNally, MSN, MA, RN, CCRN, CPHON, New York
Sherry Nelson, MSN, RN, Virginia
Madeline Perkel, MSN, RN, CRNP, CCRN, Pennsylvania
Kathleen Schmidt, MSN, RN, PNP, CCRN, New York
Susan Stafford, BSN, RN, CPN, Michigan
Karen Thomason, MSN, RN, CCRN, Colorado
Michelle Wilson, MSN, RN, CCRN, California
Requests for Copies of the PICU-BKAT6r

The BKAT is being provided at cost to nurses who work in a critical care unit as a service to nursing and to the ministry that nursing represents.  A payment of $15.00 is requested to cover our costs of photocopying, postage, handling, and continued validity and reliability testing.  Permission to use the PICU-BKAT6r and to make as many copies as are needed in your professional practice can be obtained by writing to Dr J. Toth, RN, at 

P O Box 6295
Washington, DC 20015

Author of the PICU-BKAT6r

The initial version of the BKAT (BKAT1) was co-authored by J. Toth, PhD, RN, MSN, CNS, BCCC, Washington, DC, and by Kathleen Ritchey, RN, MSN, CNS, formerly of the Veterans Administration Medical Center, Washington, DC.  All subsequent BKATs and their version were authored by Dr Toth.

Other Critical Care BKATs Available:

1.  BKAT-9r for Adult ICU (2015) 
2.  BKAT-9S for Telemetry/Progressive Care (2015)
3.  ED-BKAT3r for Adult Emergency Department (ED) (2020)
4.  NICU-BKAT5r for Neonatal ICU (2016) 
5.  PEDS-ED BKAT for the Pediatric ED (2011)  [in revision]
6.  BKAT-CC for Contagion Control (2021) [In reliability testing]

Non-Critical Care:

7.  MED-SURG BKAT2 for medical-surgical nursing (2018)

Selected References

        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.

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

Cooper, VB & Haut, C.  Preventing ventilator-associated pneumonia in children:  An evidenc4e-based protocol.   Critical Care Nurse.  2013;33(3), 21-29.

Licata, J, Aneja, RK, Kyper, C. et al.  A foundation for patient safety:  Phase I implementation of interdisciplinary bedside rounds in the Pediatric Intensive Care Unit.  Critical Care Nurse.  2013;33(3), 89-91.

Cameras, feedback:  Effective tools to enforce hand washing.  AACN Bold Voices. 2012;4(5),23.

Toth JC.  Development of the Basic Knowledge Assessment Tool (BKAT) for medical-surgical nursing (MED-SURG BKAT) © and implications for in-service educators and managers.  Nursing Forum.  2011; 46(2):110-116.

Burchell, PL, & Powers, KA.  Focus on central venous pressure monitoring in an acute care setting.  Nursing2011; December, 39-43.

Eding, DM, Jelsma, LR, Metz CJ, Steen VS, & Wincek, JM.  Innovative techniques to decrease blood exposure and minimize interruptions in pediatric continuous renal replacement therapy.   Critical Care Nurse.  2011;31(1),64-71.

Schindler CA, Mikhailov TA, Kuhn EM, Christopher J, Conway P, Ridling D, Scott AM, & Simpson VS.   American Journal of Critical Care.  2009;20(1),26-34.

Hatler, c., Buckwald, L, Salas-Allison, Z, & Murphy-Taylor, C.  Evaluating central venous catheter care in a pediatric intensive care unit.  American Journal of Critical Care.  2009;18(6),514-520.

Bell, L, Cox, B.  Central venous catheters in pediatric patients.   American Journal of Critical Care.  2009;18(6),522.

 Stravroudis, TA, Miller, MR, & Lehmann, CU.  Medication errors in neonates.   Clinics in Perinatology.  2008;35,141-161.

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.

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

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.

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 impact on nosocomial infection. Pediatrics. 2004;114(5),565-571.

Aari, R-L, 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.

Moore, KA, 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 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

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.

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.

JT 2/20/20