The OCTOPUS study - a qualitative ethnography study
Research type
Research Study
Full title
A qualitative ethnography study to explore how venous leg ulcer care is delivered in a National Health Service (NHS) hospital trust in England
IRAS ID
338620
Contact name
David Wright
Contact email
Sponsor organisation
University of Leicester
Duration of Study in the UK
0 years, 6 months, 0 days
Research summary
Research Summary:
Based on the national guidance, everyone with venous leg ulcers should be provided with compression therapies. However, when people with venous leg ulcers are admitted to hospitals for any reason, it is common that their compression treatment is not maintained by hospital clinicians. This means peoples' venous leg ulcers can become worse and they are unlikely to heal.This ethnographic study aims to explore venous leg ulcer care regarding using or not using compression therapy for inpatients with venous leg ulcers.
To achieve the study aim, I plan to immerse myself in conducting direct observations of venous leg ulcer care in different clinical settings in one hospital trust. I also plan to interview clinicians involved at the point of care provision and clinical decision-makings.
I aim to define how hospital clinicians provide or not provide venous leg ulcer care and identify work processes and social agreements between hospital clinicians caring for inpatients with venous leg ulcers. These observations will provide insights into activities and dynamics which other types of reports or interviews often do not report. The observations will also gain the sorts of data which will be relevant to understanding the world of these settings, namely how clinicians interact with each other, interact with patients with venous leg ulcers in their clinical settings and interact with the space, objects and equipment in inpatient wards when providing venous leg ulcer care in their hospitals. These elements could be important factors that contribute to the identification of barriers and enablers of implementing compression therapy in hospital settings.
This study findings, alongside the interview study data will inform the development of behaviour change techniques, which are designed to improve the implementation of compression therapy for inpatients with venous leg ulcers. This is in line with national guidelines for managing venous leg ulcers.
Summary of Results:
Venous leg ulcers are common among patients in NHS hospitals, but there is very little research on how their care is managed in hospital settings. This study looked at how compression therapy—a key treatment for venous leg ulcers—is actually provided (or not provided) to patients during their hospital stay.The research was carried out in one NHS Trust in England where a two-layer compression bandage system had been introduced by the Tissue Viability team. Over six months, the researcher (YL) observed care on wards for 110 hours and recorded 71 episodes of care. They also interviewed 53 staff members, including specialist nurses, ward nurses, senior sisters, matrons, junior doctors, and consultants. Trust documents and anonymised photos were also reviewed. The data was analysed using thematic analysis.
What the study found:
• Introducing the two-layer bandage was a positive step, but many patients still did not receive compression therapy during their stay.
• Three main reasons emerged:
1. Priority Tensions – Different priorities between the Trust, specialist nurses, ward nurses, and doctors.
2. Fear of Compression Therapy – Staff were worried about risks or complications.
3. Fear of Workload Burden – Staff were concerned about the extra work involved.
4. Fear of the Unknown - Staff were fearful of the compression therapy due to limited leg ulcer knowledge and compression application skills 5. There was also confusion about who is responsible for venous ulcer care within the hospital.Conclusion: Improving venous ulcer care in hospitals needs more than just introducing new bandages. It requires understanding that this is a complex intervention and considering the hospital culture and environment. A system-wide approach is needed, involving all key staff and managers. Future work should focus on identifying behaviours that make compression therapy easier to apply and aligning hospital priorities to meet the needs of elderly patients with venous leg ulcers.
REC name
South Central - Oxford B Research Ethics Committee
REC reference
25/SC/0043
Date of REC Opinion
3 Mar 2025
REC opinion
Further Information Favourable Opinion