The Basic Knowledge Assessment Tool (BKAT) for
The Pediatric Emergency Department
PEDS-ED BKAT (copyrighted)
(Version One, 2011)


Basic knowledge in the Pediatric Emergency Department is a body of knowledge 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 Pediatric Emergency Department nursing and represents the foundation for job performance.

A primary aim of in-service education is to assure that critical care 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 31 years, it has become accepted as one standard for measuring basic knowledge in various areas of critical care nursing.  For example, to date, over 10,300 critical care nurse educators and nurse managers in the USA have requested and have received a copy of the BKAT to photocopy for use in their practice.  Critical care nurses in over 23 different foreign countries have also requested and received a copy of one of the BKATs. 

However, a review of the literature failed to locate a standardized test of basic knowledge in Pediatric Emergency Department nursing.  It was in response to this finding and inquiries from PEDS-ED nurses, that this research was begun. 


The PEDS-ED BKAT is an 80-item paper and pencil test that measures basic knowledge in Pediatric Emergency Department nursing.  These items measure content related to the following areas of nursing practice:  cardiovascular (14 items), neurology (10 items), pulmonary (9 items), pediatric trauma (8 items), endocrine (6 items), gastrointestinal (4 items), renal (4 items), and an ‘other’ category (25 items). The category ‘other’ includes 3 items each in drug abuse/calculation, fever/sepsis, and psychiatric situations; it also contains two items each in ethical/Spiritual care, hypothermia, OB/GYN, and pain management.  Furthermore, each of the following content areas has one item:  blood transfusion, burns, child’s play, conscious sedation, drowning, immunization, mass casualty, and obesity. 

The PEDS-ED BKAT takes approximately 40 minutes to complete.  The total possible score is 80 points (100%).  Items on the test 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 nursing practice are integrated into specific questions in the PEDS-ED BKAT.  Possible scores range from zero to 80 points with a high score indicating a high degree of basic knowledge in Pediatric Emergency Department nursing.

     To see sample questions, Click Here


Content for the initial 89-item version of the PEDS-ED BKAT was identified through clinical experience, a review of the literature, interviews with staff nurses working in pediatric Emergency Department nursing, and items from the following BKATs:  The Emergency Department (adults and children, a 100 item test), the Pediatric ICU BKAT5 (a 90 item test), and the NICU-BKAT4 (a 75 item test). 

Construct validity.   The construct, basic knowledge, was supported through suggestions from two Panels of Experts in Emergency Department nursing practice and education.  The first Panel of Experts included four members who reviewed potential items once for the PEDS-ED BKAT from the PEDS-BKAT5, the NICU-BKAT4, and the ED-BKAT.   A total of 64 items were used from the ED- BKAT.  Of these, 37 were modified to better reflect Pediatric Emergency Department nursing.  Modifications included changes in stems, answers, and/or distractors. 

In addition, 11 items were used from the PEDS- BKAT5.  Of these, 9 were modified to better reflect Pediatric Emergency Department nursing.  Modifications also included changes in stems, answers, and/or distractors.   Thirdly, 8 items were used from the NICU-BKAT4 and five were modified.  Modifications once again included changes to stems, answers, and/or distractors.  Fourthly, six completely new items were written by Panel members for what became the initial version of the

The second Panel of Experts included two members who reviewed the initial 89 item version of the PEDS-ED BKAT described above.  Comments from this Panel were incorporated into the revised PEDS-ED BKAT that was used for reliability testing.

During reliability testing, item analyses were used to improve the PEDS-ED BKAT.   These changes included deleting 9 items that did not discriminate between nurses who did well on the test and those who did not do well (low item to total correlations), leaving the current 80 item PEDS-ED BKAT.  Clarity was improved by changing answers in two questions and in stems of five additional questions.  In addition, changes were done in  distractors of 19 questions.

Known group differences was not done, due to the small number of new graduate nurses in the sample.  However, a statistically significant correlation between scores on the PEDS-ED BKAT and years of experience in the pediatric emergency department was found [r(140)=.336, p <.0005, one-tail] or as years of experience increased, basic knowledge also increased.  Since knowledge increases with practice, this lends additional support that the PEDS-ED BKAT measures the construct of basic knowledge.

Reliability and Averge Scores

Reliability.  Cronbach’s Coefficient Alpha (a) was used to measure the internal consistency reliability of the PEDS-ED BKAT.   Reliability was a=0.71, computed on 140 nurses.  This is described below, under sample studied. 

Averge Score.  No one is expected to achieve 100%.  Rather, it is expected that following orientation, pediatric emergency department nurses will achieve an average score.  The average score for this study was 79% correct answers.  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 PEDS-ED.  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.

The Sample Studied

The sample used in this research included 140 nurses working in a Pediatric Emergency Department at the time they answered the PEDS-ED BKAT.  Scores ranged from 52 (58.4%) to
86 (96.6%), with a mean (M)=70.5 (79.2%) and a standard deviation (SD) of 6.1 points.  The type of units in which the subjects worked included a Pediatric ED [n=97 (69.7%)], an Adult ED with a PEDS area [n= 38(27.5%)], a mixed Adult and Peds ED without a PEDS area [n=2 (1.4%)], and two subjects who worked with the Medivac of Peds patients [n=2 (1.4%)].  An independent t-test was computed on scores between the nurses working in the Pediatric ED and the adult ED with a PEDS area, and was not found to be different [t(133)=1.6, p>.05, NS].

Years worked in the Pediatric ED or Adult/Peds ED ranged from zero (10.2%) to 30 years. The mean age was 8.9 years (median=5.5), and SD=8.8 years.  The majority held a bachelors degree in nursing (53.0%), followed by an associate degree (29.9%), a master’s degree (10.4%), and a diploma (6.7%).  None of the nurses was doctorally prepared.  Thirteen were new graduates (9.3%). The primary position in nursing was staff nurse (86.5%), followed by head nurse/manager/supervisor (4.5%), in-service educator (6.0%), and clinical specialist and pediatric nurse practitioner (1.5%) each.  The type of hospitals included children’s (55.6%), community/teaching (40.7%), and other including county government, university, and community-non-teaching (3.6%).  Over one-fourth of the nurses were certified in pediatric nursing (28.6%) and the remainder were not.

Uses of the BKAT

The BKAT can be used prior to orientation classes in Pediatric Emergency Department 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 Pediatric Emergency Department nurses.  The BKAT is only one measure of basic knowledge in Pediatric Emergency Department 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.  It may not be put on any computer for any reason.

Panel of Experts for the PEDS-ED BKAT

The Panels of Experts include the following pediatric critical care nurses:

Kathleen Buckley, RN, PhD, Maryland
Maureen Garcia, RN, MSN, CEN, Maryland
Jennifer Hinrichs, RN, MSN, CCRN, Washington, DC
Erika Kreifels, RN, BSN, Tennessee
Deborah Newton, EMT, RN, BFA, CEN, Kentucky
Kristen Woods, RN, MSN, CPNP, Maryland

Data Collectors for the PEDS-ED BKAT

Elaine Beardsley, RN, MN, CPEN, Washington
AnnMarie Chase, RN, MSN, CEN, Massachusetts
Kimberly Choppi, RN, BSN, CPEN, Arizona
Terry Dean, RN, MS, Massachusetts
Jayne Febbraro, RN, MSN, CRNP, Pennsylvania
Mary Gniady, RN, MS, APRN, CCNS, NP-C, CEN, Illinois
Marty Hay, RN, BSN, CPEN, ENPC-1, California
Mary Ann Hoffmans, RN, BC, MN, Texas
Rachel Jenner, RN, MSN, CEN, New Jersey
Kellie Kilrain, RN, BSN, SANE-P, Indiana
Erika Kreifels, RN, BSN, Tennessee
Janet Modde, RN, BSN, Missouri
Sue Moore, RNC, CPN, ENPC, Florida
Terry Pye, RN, MSN, ARNP-BC, CPEN, Florida
Dana Reed, RN, BS, CCRN, New Jersey
Jan Rhoads, RN, MSN, CEN, Pennsylvania
Roxene Riles, RN, BSN, MSN, PhD[c], Florida
Shelly Whitaker, RN, CEN, Michigan
Flora Tomoyasu, RN, MSN, CNS, California

Authors of the BKAT

The initial version of the BKAT (BKAT-1) was developed for use in the adult intensive care unit and was co-authored by Jean C Toth, PhD, RN, MSN, CNS, 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 BKATs Available

Adult Critical Care:
BKAT-8 for the Adult Intensive Care Unit (ICU) (2009)
BKAT-8S for Telemetry/Progressive Intensive Care (2010)
ED-BKAT2 for Emergency Department (2012)

Pediatric Critical Care:

PICU-BKAT6r for Pediatric Intensive Care Unit (ICU)
NICU4-BKAT for Neonatal ICU (2009)

Non-Critical Care:

MED-SURG BKAT for Medical/Surgical nursing (2010)

Official BKAT Website:

Selected References 

Toth, JC.  Development of the Basic Knowledge Assessment Tool For Medical-Surgical Nursing (MED-SURG BKAT), and Implications for In-Service Educators and Managers.  (2011).  Nursing Forum (Accepted for Publication).

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.

Morris, LL, Pfeifer, PB, Catalano, R, Fortney, R, Hilton, EL, McLaughlin, J, Nelson, G, Palamone, J, Rabito, R, Wetzel, R, & Goldstein, L.  Designing a comprehensive model for critical care orientation.  Critical Care Nurse.  2007;27(6): 37-60.

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.

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.

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.

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

Messmer PR, Jones SG, Rosillo C.  Using nursing research projects to meet Magnet recognition program standards.  Journal of Nursing Administration. 2002;32(10):538-543.

Holcomb S, Posea K. Homegrown: CC interns take root.  Nursing Management. 2001;32(5):38-39.

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.

Recker D, O’Brien C.  Reliability and validity of critical care orientation tests.  J Cont Educ Nurs.  1995;26(1):21-27.

Toth JC.  Basic Knowledge Assessment Tool for critical care nursing, Version Four (BKAT-4):  Validity, reliability, and replication.  Critical Care Nurse.  1994;14(3):111-117.

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.  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 JC.  Evaluating the use of the Basic Knowledge Assessment Tool (BKAT) in  critical care nursing with baccalaureate nursing students. Image:  The Journal of Nursing Scholarship.  1984;16(3):67-71.

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 2/14/11