Certified Registered Nurse Anesthetist Nonsurgical Pain Management Infection Prevention Competencies

Monday, 22 July 2013: 10:45 AM

Lisa J. Thiemann, PhD, CRNA
National Board of Certification and Recertification for Nurse Anesthetists, Chicago, IL

Learning Objective 1: Describe the role of the certified registered nurse anesthetist in nonsurgical pain management.

Learning Objective 2: Describe the nonsurgical pain management infection prevention competencies for trigger point injections, epidural steroid injections, and sacroiliac joint injections.


To define infection prevention competencies associated with certified registered nurse anesthetist (CRNA) delivered nonsurgical pain management (NSPM).  


The Dreyfus Model of Skill Acquisition as utilized by Benner served as the theoretical basis for this study. A descriptive study using a classical Lockean Delphi technique was conducted to achieve consensus regarding the requisite CRNA infection prevention competencies for the three most commonly performed NSPM procedures. Expert panelist interviews using a structured questionnaire were conducted, and thematic analysis of the content was completed. Electronic validation of the proposed infection prevention and control competency domains, statements and terminal objectives by the expert panelists followed. Self-identified NSPM CRNAs contributed data during later Delphi iterations using the validated survey.


Expert Panelists validated a Delphi survey consisting of four competency domains, 13 competency statements, and 43 terminal objectives with a 100% response rate. All four competency domains, 13 competency statements, and 39 of the terminal objectives achieved consensus with the self-identified CRNA NSPM practitioners with a 14.2% response rate. The terminal objectives failing to achieve consensus were: when performing lumbar epidural steroid or sacroiliac joint injections, wears a sterile gown; when performing trigger point injections (TPIs), wears a hat; when performing TPIs, uses a sterile drape; and, completes a minimum of one continuing education unit specific to infection prevention annually.


The outcomes of this work will assist in developing standards to enhance quality and safety in patient care. With extensive background and understanding of pain management, CRNAs are positioned to serve society’s need for pain management professionals. Similarly, nurse anesthetists around the globe who directly or indirectly care for patients experiencing pain may benefit from this study’s findings. With continual reports regarding infection transmission associated with pain-related procedures, this research study has identified targeted areas for pain practitioner continuing education.