ELICITING FORENSIC NURSES’ VOICES: SEXUAL ASSAULT NURSE EXAMINERS’ LIVED EXPERIENCES OF PRACTICE, CONSTRAINT, AND EMANCIPATORY COMPASSION

Abstract

Abstract Background: Sexual Assault Nurse Examiners (SANEs) provide trauma-informed, patient-centered care at the intersection of healthcare and the criminal justice system. Despite their critical role, SANE practice is shaped by structural constraints, regulatory variability, and competing institutional priorities that may conflict with holistic nursing care and values. Purpose: To explore how SANEs make meaning of enacting holistic, trauma-informed care to all populations within structurally complex healthcare and legal systems. Methods: This descriptive qualitative study used interpretative phenomenological analysis (IPA) to examine the lived experiences of 24 practicing SANEs in the Midwestern United States. Participants were recruited through purposive and snowball sampling through professional networks. Data were collected through semi-structured interviews, audio-recorded, transcribed verbatim, and analyzed using idiographic and cross-case thematic analysis. Rigor was supported through reflexive journaling, peer debriefing, and an audit trail, with reporting guided by COREQ. Results: Six superordinate themes were identified: 1) Enacting Holistic; Trauma-Informed, Patient Centered Forensic Nursing Practice, 2) Humanistic Connection as the Foundation of Care, 3) Enacting Holistic, Patient-Centered Forensic Nursing in Real-World Practice, 4) Providing Holistic SANE Care Under Pressure and Moral Conflict, 5) Education as a Starting Point and Learning Beyond Training in Practice, 6) Learning in Practice: Experiential Knowledge and the Development of Clinical Judgment. Conclusions: SANE practice is both relational and structurally mediated. Findings highlight the need for organizational, educational, and policy reforms that support trauma-informed care, workforce sustainability, and equitable forensic nursing practice. This study contributes to forensic nursing scholarship by centering the voices of SANEs and advancing understanding of how holistic care is negotiated within complex institutional systems. Findings have implications for policy, education, workforce development, and organizational support structures aimed at strengthening equitable, trauma-informed forensic nursing practice and sustaining the SANE workforce.