Gum Chewing Aids Bowel Function Return and Analgesic Requirements After Bowel Surgery

This study examines the effect of gum chewing on bowel function return and analgesic requirements after bowel surgery. The results show that gum chewing can help improve bowel function and reduce the need for pain medication in post-operative patients.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Part 2
Answer1
Short-terms are like keywords. It helps to fetch out accurate and relevant articles from
the databases. The use of long descriptive sentences might increase the overall search time
and decrease the number of relevant hits (Parahoo 2014).
Answer 2
The short-terms are required to be specific. Here specific terms means the terms
which coincide with the scope of the research questions or the research topic. The use of the
specific terms instead of broad terms helps to decrease the search time and relevancy of the
search (Parahoo 2014).
Answer 3
Tanner’s Model of Clinical Judgement defines the importance of the clinical
judgement of a nursing professional over observation, analysis or reflection of any available
information. The clinical judgement of a nursing professional is mainly guided by the
evidence based practice. As per the available evidences, the nurses guides themselves in the
decision making process. This is the underlying relationship between the Tanner’s Model of
the Clinical Judgement and Evidence Based Practice (Cappelletti, Engel and Prentice 2014).
According to Cappelletti, Engel and Prentice (2014) evidence based practice is generated
through the available clinical expertise with proven positive results over the overall
progression in the therapy plan and the patients’ well-being. Thus on the basis of the
evidences, the final clinical judgement of the nursing professional is being directed. Tanner’s
Clinical Judgement Model is based over 200 research studies depending on the way over
which the nursing professional have acted upon. The process of clinical judgement as per the

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Tanner’s model is mainly modulated by noticing, interpreting, responding and reflection of
the current practice (Cappelletti, Engel and Prentice 2014).
Answer 4
Systematic review is a review of the randomised controls trials made over any
common research topic. This falls under the level one of the evidence based practice.
Systematic review over the randomised control trials help in the generation of the evidence
based practice (Parahoo 2014).
Part: 3
Answer 5
According to Hemming et al. (2015), randomised control trails (RCTs) help to
increase the overall quality of the research via decreasing the chances of getting biased
outcomes.
Answer: 6
Primary outcome: Time of discharge, time of first flatus and time of first bowel
motion.
Secondary outcome: Pain and total morphine equivalent medicine for seven days and
Complications rates
Answer 7
The pain was accessed on the basis of the pains score in the scale of 0 to 10. 10 is the
worst condition. Pain was recorded during patient’s bowel movement

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Answer 8
The sample size of the study was 162 with 81 in each arm. According to Hemming et
al. (2015), the sample size which is over 100 is regarded as a permissible sample size for the
conduction of the randomised control trial.
Answer: 9
The base-line difference between intervention and control group participants was
same during the initiation of the study. Hemming et al. (2015) are of the opinion that lower
baseline difference leads to uniform recruited of the sample in both the groups leading to the
generation of more unbiased results with reduce effect from confounding factors.
Answer 10
Lack of blinding among the patients might increase the chance of getting biased
outputs. This may lead to misappropriate self-reported diagnosis of the level of pain and thus
hampering the dosage of analgesic leading to biased results.
Answer 11
As per the study, chewing gum was not helpful in reducing the overall length of the
stay at the hospital. No difference was found in the length of stay at the hospital between the
CG (chewing gum group) (5.8 days) and the non-chewing gum groups (NG ) (6.1 days, P =
0.403)
Answer 12.
The TBM was lower in the CG (data recorded was: 40.0 median hours) in comparison
to the NG (90.0 median hours, P = 0.002). This showed significant difference and thus
providing chewing gum to be effective in reducing the median time to first bowel motion.

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Answer 13.
The confidence interval of the treatment group was 0.032 (1.4 [1.0-2.0]) and that of
the surgery group was < 0.001 (2.1 [1.5-3.0]). This showed statistical significance and thus
potential output.
Answer 14
Mean required morphine for the chewing gum group was 41.0 (85.7) and mean
required morphine for the non-chewing gum group was 61.3 (77.8). The difference has the P
value of 0.009. This showed significant difference and decreased requirement of morphine in
chewing gum group.
Answer 15
Yes. The overall analysis showed statistical significant and thus I will consider the use
of the chewing gum among the post-operative adult patients expect the patients from the
rectal surgery or post colo-rectal patients. However, clinical significance is less as they used
only adults, did not used medicated chewing gums and failed to conducted additional trails to
replicate the results.
Answer: 16
One of the limitations of the study towards its implementation the new research
findings in the clinical practice is, the study only recruited adult individuals. According to the
Byrne et al. (2018), all adult patients who are undergoing elective open or laparoscopic bowel
surgery are recruited in the study. As per the study conducted by Pellino et al. (2014), the
post operative paediatric patients with ileal-pouch anal anastomosis (IPAA) and with
paediatric ulcerative colitis (UC) has a poor quality of life in the post surgical conditions.
Moreover, Carter et al. (2014) stated that the use of analgesic among children in the post-
operative care is associated with several side-effects in comparison to the adults such that

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reduced dosage of analgesic is recommended. However, reduced dosage of analgesic
hampers the quality of life of the patients. However, since the study conducted by Byrne et al.
(2018) did not included children, the implementation of this research finding can be done
over children taking under the ethical complications.
Another limitation of the study is the authors excluded patients who are suffering
from the rectal resections are not recruited in the study. However, the study conducted by
Van den Heijkant et al. (2015) highlighted that chewing of gum is effective for the post colo-
rectal surgery patients. Thus, use of the chewing gum in this case might have been helpful to
study the effect of chewing gum in reducing the use of analgesic among the post-operative
patients of colo-rectal surgery. Thus under the clinical practice, it is not applicable for the
post-operative colo-rectal patients. In other words, it can be said that this study is not
comprehensive in order to be applicable clinically over a wide variety of patients.
Another barrier in the study is, use of the chewing gum or the use of the external
material is not always permissible in the post-surgical unit. Sun and Migaly (2016) are of the
opinion that the use of the external material in the post-operative patients might be harmful.
This is because, post-operative patients mainly suffers from the immune-deficiency and thus
use of non-sterilized or non-medicated things for both internal and external use, might
increase the overall chance of developing cross-infection and thereby increasing the length of
the hospital stay. Garg and Goyal (2014) mainly recommended the use of the medicated
chewing gums. Since, Byrne et al. (2018) did not used medicated chewing gums; the results
might not be applicable under clinical practice. Moreover, the exact dosage, that is amount of
the chewing gum (in grams) that was used for 15 minutes, for 4 times a day for 14
consecutive days was not mentioned.

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The study conducted by Short et al. (2015) was based on the similar approach as the
study, which was conducted by the Byrne et al. (2018). According to the review of Short et
al. (2015), there are few potential benefits of using post-operative chewing gum in order to
improve the overall function of the gastro-intestinal tract. However, with the use of the poor
quality trail that is single trials based over relatively small sample size might not be effective
in order to implement the research findings in the clinical practice. Moreover, Short et al.
(2015) further stated that the majority of the ERAS package targets ileus and thus the benefits
of chewing gum along with the use of ERAS might have been reduced. The scenario is same
in the study of Byrne et al. (2018). Though Byrne et al. (2018) conducted randomized control
trial, the overall sample size is relatively small (162) in order to implement its results into
clinical practice. Moreover, wider trails are required to be undertaken in order to establish it
as a practice.
Answer: 17
As a junior clinical, my overall learning experience from this subject, was very
fulfilling. It helped me to understand the role and the importance of the evidence practice in
the healthcare settings. Under the evidence based practice, it can be said that it is the duty of
the healthcare professional to go thoroughly over the established evidence before
implementing the required intervention it over a patient or a group of patient. However, while
reviewing this paper, I found that results highlighted in this trail, might not be suitable for the
comprehensive application over a wide array of population. Thus while coming across this
kind of trails, I will keep into consideration the overall aspect of the identified results before
applying it. I will also make use of the patient-centred care approach in order to increase the
overall outcome of the care of the patients.

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References
Byrne, C. M., Zahid, A., Young, J. M., Solomon, M. J., and Young, C. J. 2018. Gum chewing
aids bowel function return and analgesic requirements after bowel surgery: a randomized
controlled trial. Colorectal Disease, 20(5), 438-448.
Cappelletti, A., Engel, J.K. and Prentice, D., 2014. Systematic review of clinical judgment
and reasoning in nursing. Journal of Nursing Education, 53(8), pp.453-458.
Carter, G. T., Duong, V., Ho, S., Ngo, K. C., Greer, C. L., and Weeks, D. L. 2014. Side
effects of commonly prescribed analgesic medications. Physical Medicine and Rehabilitation
Clinics, 25(2), 457-470.
Garg, T., and K Goyal, A. 2014. Medicated chewing gum: patient compliance oral drug
delivery system. Drug delivery letters, 4(1), 72-78.
Hemming, K., Haines, T. P., Chilton, P. J., Girling, A. J., and Lilford, R. J. 2015. The stepped
wedge cluster randomised trial: rationale, design, analysis, and reporting. Bmj, 350, h391.
Parahoo, K., 2014. Nursing research: principles, process and issues. Macmillan International
Higher Education.
Pellino, G., Sciaudone, G., Miele, E., Candilio, G., Fatico, D., Serena, G., ... and Selvaggi, F.
2014. Functional outcomes and quality of life after restorative proctocolectomy in paediatric
patients: a case-control study. Gastroenterology research and practice, 2014.
Short, V., Herbert, G., Perry, R., Atkinson, C., Ness, A. R., Penfold, C., ... and Lewis, S. J.
2015. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane
Database of Systematic Reviews, (2).

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Sun, Z., and Migaly, J. 2016. Review of hemorrhoid disease: presentation and
management. Clinics in colon and rectal surgery, 29(01), 022-029.
Van den Heijkant, T. C., Costes, L. M. M., Van der Lee, D. G. C., Aerts, B., Osinga‐de Jong,
M., Rutten, H. R. M., ... and Luyer, M. D. P. 2015. Randomized clinical trial of the effect of
gum chewing on postoperative ileus and inflammation in colorectal surgery. British Journal
of Surgery, 102(3), 202-211.