# A Qualitative Study Examining the Application of Compression Therapy for Inpatients With Venous Leg Ulcers—Perspectives of Hospital Staff Where It Is Routinely Applied

## TL;DR

This study explores why compression therapy for venous leg ulcers is inconsistently applied in UK hospitals, based on interviews with hospital staff.

## Contribution

The paper provides new qualitative insights into systemic and organizational barriers to implementing compression therapy for inpatients with venous leg ulcers.

## Key findings

- Compression therapy access is unequal within and between hospitals, with patients 'slipping through the net'.
- Systemic issues like unclear ownership and interprofessional disputes hinder consistent therapy application.
- Clinicians' motivation and ethical commitment drive therapy use despite systemic challenges.

## Abstract

Compression therapy is the cornerstone, first‐line effective evidence‐based treatment for healing and managing venous leg ulcers. However, compression therapy is inconsistently applied in hospitals. This paper explores the experiences of a diverse group of clinicians and senior managers applying compression therapy in hospitals across the United Kingdom. A semi‐structured qualitative interview study was conducted with 19 participants, drawn from a larger study, who confirmed that their respective hospitals apply compression therapy to inpatients with venous leg ulcers. The interviews were analysed using reflexive thematic analysis. Analysis generated four key themes: Patients ‘slip through the net’, Prioritisation in Hospital Care, A ‘blind Spot’ within Healthcare System and Motivation to Deliver Care. Patients ‘slip through the net’ refers to inpatients with venous leg ulcers face unequal access to compression therapy both within and between hospitals. Prioritisation in Hospital Care indicates how certain diseases are given greater emphasis within healthcare systems. A ‘blind Spot’ in Healthcare System described failing to implement compression therapy has created a critical underlying ‘blind spot’ within the NHS healthcare systems. Motivation to Deliver Care refers to a deep commitment to providing compression therapy, driven by clinicians' inherent dedication and ethical obligation towards improving patient quality of care. The study identified key challenges influencing the application of compression therapy in acute hospitals despite its routine use. These include the lottery of care, systemic inequities, unclear ownership, interprofessional disputes and organisational priorities. It also demonstrated the significant role of passion, motivation and moral responsibility encouraging clinicians to implement compression therapy despite these systemic barriers.

The study emphasised the urgent need to explore the systemic challenges inherent in inpatient venous leg ulcer care. Once this is addressed, establishing a standardised, evidence‐based care pathway with clearly defined roles and responsibilities will be paramount to ensure that all inpatients with venous leg ulcers receive timely and appropriate venous leg ulcer management in acute hospitals.