In united states the incidence of postoperative ileus occurs in approximately 50% of clients who undergo major abdominal surgery.
In india 60 to 70% of clients with major abdominal surgery develop complication due to post operative complication due to post operative paralytic ileus which becomes the root cause for discomfort, prolonged hospital stay and economic burden.
DEFINITION-POSTOPERATIVE PARALYTIC ILEUS
Post operative paralytic ileus is generally defined as a transient impairement of bowel motility after abdominal surgery, clinically characterized by bowel distention, lack of bowel sound and lack of passage of flatus and stool. In postoperative ileus, inhibition or small bowel motility is transient, and the stomach recovers within 24 to 48 hours, whereas colonic function takes 48 to 72 hours to return. Not all segments in the gastro intestinal tract are equally affected by postoperative paralytic ileus. The average paralytic state lasts between 24 to 72 hours. Twenty four hours in the small intestine, 24 to 34 hours in the stomach and between 48 to 72 hours iin the colon after major abdominal surgery. The effective duration of paralytic ileus is there for mainly on the return of colonic motility and in particular motility of the left colon.
ETIOLOGY
The pathogenisis of postoperative paralytic ileus is complex with multiple factors. These factors include inhibitory effects of sympathetic input, release of hormones, neurotransmitters and other mediators, an inflammatory reaction and the effects of anasthetics and analgesics.
DIAGNOSIS
Postoperative paralytic ileus can be diagnosed by timing of relatively low pitched, gurgling sound caused by the propulsion of the intestinal contents through the lower alimentary tract which is characterized by peristaltic movement, passage of gas and evacuation of faeces.
TRADITIONAL TREATMENT
Nasogastric intubation.
Electrical stimulation of the intestine.
Early postoperative feeding.
Medications like opoid antagonist(Methylnatrexone and alvimopan),prokinetic agents(bisacodyl), motilin receptor antagonist(erythromycin), dopaminergic antagonist(metaclopromide) are used.
CONTEMPORARY TREATMENT
A review of meta-analyses and randomized controlled trials on drugs used for post-operative ileus was reported by Yeh et al. There are three meta-analyses (2 on gum-chewing and 1 on alvimopan) and 18 clinical trials. Only gum chewing and alvimopan were effective in preventing ileus but due to safety concerns and costs with alvimopan, gum chewing may be preferred as first-line therapy.
SIGIFICANCE AND NEED FOR THE STUDY
Paralytic ileus is a significant medical problem and constitutes the most common reason for delayed discharge from the hospital after abdominal surgery. The economic impact of ileus has been estimated to be $750 million to $1 billion in the united states. More important than health care costs is patient discomfort. So the researcher found that after major abdominal surgery the postoperative paralytic ileus is the major problem. And the gum chewing aids early recovery from postoperative ileus and is an inexpensive and physiologic method for stimulating bowel motility. Gum chewing should be added as an adjuant treatment in postoperative care because it might contribute to shorter hospital stays.
Cavusoglu.Y.H, et al,(2008) they performed a prospective, randomized, controlled trial on chewing gum prevents the onset of paralytic ileus in Dr.Sami ulus hospital, Turkey. Addition of gum chewing to the standardized postoperative care of children with anastamosis was associated with a significantly earlier return of bowel function compared to simple postoperative management, and it was associated with an earlier discharge from hospital, although this earlier discharge had only minor clinical significance was found in hospital charges.
Fitzgerald JE, Ahmed I.(2009), in Nottingham they conducted a study on systematic review and meta-analysis of chewing-gum therapy in the reduction of postoperative paralytic ileus following gastrointestinal surgery. There were no significant differences in complication rates. Chewing-gum therapy following open gastrointestinal surgery is beneficial in reducing the period of postoperative ileus, although without a significant reduction in length of hospital stay. These outcomes are not significant for laparoscopic gastrointestinal surgery.
Hirayama I, Suzuki M, et.al,(2009), conducted a study on gum-chewing stimulates bowel motility after surgery for colorectal cancer in Gunma Prefectural Cancer Center, Japan. The first passage of flatus and stool in the chewing-gum group after operation were 35 and 50 hours, respectively, sooner for the controls. It was concluded that gum-chewing provides a simple and effective method to improve the postoperative state of clients.
With the use of literature review the researacher found that postoperative paralytic ileus is the major complication after the major abdominal surgery, and it will increasing the hospital stay. As the researcher came across many cases with increasing hospital stay due to later bowel motility. Gum chewing aids early recovery from postoperative ileus and is an inexpensive and physiologic method for stimulating bowel motility and also it reduces the hospital stay. Based on this fact the researcher felt the need to assess the effectiveness of chewing gum among clients undergone major abdominal surgery.
STATEMENT OF THE PROBLEM
A quasi experimental study to evaluate the effectiveness of chewing gum in increasing bowel motility among clients undergone major abdominal surgery in selected hospital, Madurai.
OBJECTIVES
To assess the level of bowel motility among clients undergone major abdominal surgery in control group.
To assess the level of bowel motility after administering chewing gum among clients undergone major abdominal surgery in experimental group.
To findout the difference in the level of bowel motility between experimental and control group.
To associate the relationship between the level of bowel motility and selected demographic variables among clients undergone major abdominal surgery.
NULL HYPHOTHESIS
Ho1 : There will be no association between the chewing gum and bowel motility among clients undergone major abdominal surgery .
Ho2 : There will be no significant association between the bowel motility with selected demographic variables after administering the chewing gum.
OPERATIONAL DEFINITIONS
Effectiveness: In this study it refers to how well a treatment of chewing gum works in practice to increasing the bowel motility.
Chewing gum: In this study it refers that it is sugar free chewing gum consists of artificial sweetner(sorbitol). It is believed to enhance vagal cholinergic stimulation of gut, release of gastro intestinal hormone such as: gastrin, pancreatic polypeptide, and neurotensin. It was given three times a day from 25th hour postoperatively till the first defecation.
Bowel motility: In this study it refers that assessment of bowel motility involved three components.
High pitched, gurgling bowel sounds 5-7/minute is normal which assessed by auscultation method.
Passing of gas and
Defecation was assessed by subjective report of the patient.
Major abdominal surgery: In this study it refers to the laporotomy surgeries. The surgeries were the hemicolectomy, intestinal perforation closure & cholicystectomy.
ASSUMPTIONS
Chewing gum :
is simple to administer.
acts as a non-stimulant laxatives.
increases the vagal cholinergic stimulation of gut and improve the secretions of Gastro Intestinal hormones such as gastrin, neuropectin and pancreatic polypeptidase.
increases the salivation and provide freshness.
prevents the halitosis.
decreases the mental stress.
provides relaxation
will not cause any adverse effects.
DELIMITATION
Selection of sample by purposive sampling method.
PROJECTED OUTCOME
The findings of the study will help to identify the effectiveness of chewing gum therapy in increasing the bowel motility among the clients undergone major abdominal surgery. It would be useful contribution for improving nursing care and reducing the length of hospital stay.
METHODOLOGY
This chapter deals with description of the different steps undertaken by the investigator for this study. It includes the research design, variables, setting, population, sample size, sampling criteria, description of the tool, content validity, pilot study, data collection procedure and plan for data analysis, and protection of human rights.
RESEARCH APPROACH
An experimental approach was used for this study.
RESEARCH DESIGN
In this study quasi experimental design with control group post test only design was used.
SETTING OF THE STUDY
The study was conducted in Government Rajaji Hospital, Madurai, which is 5 kilometers away from C.S.I Jeyaraj Annapackiam College Of Nursing. It was established in 1842 and converted as Teaching Hospital in 1956. Area of the Hospital: 12.47 Acres, Plinth Area: 104558 Sq.mrs. This hospital includes all the multispeciality department as follows: accident and emergency, cardiology, cardio thoracic surgery, dental, E.N.T, endocrinology, general medicine, general surgery, leprosy, nephrology, neurology, neuro surgery, oncology, orthopedics, plastic surgery, psychiatry, head injury, ICU/IMCU, obstetrics and gynecology, pediatric medicine and surgery, family planning, radiology, skin, STD, T.B, urology, vascular surgery, sidha. In general surgery averagly they were done nearly 600 cases per month includes the major and minor surgery.
VARABLES
The catageories of variables discussed in this study were,
Independent variable: Chewing gum
Dependent variable : Bowel motility
POPULATION
Target population includes all the clients undergone major abdominal surgery in Madurai.
Accessible population includes the clients undergone major abdominal surgery admitted in selected hospital, Madurai.
SAMPLE
The sample consist of clients who are undergone hemicolectomy, intestinal perforation closure and cholicystectomy surgeries in Government Rajaji Hospital, Madurai during the study and who fulfills the inclusion and exclusion criteria.
SAMPLING TECHNIQUE
Purposive sampling technique was used in this study.
SAMPLING CRITERIA
Inclusion criteria
Clients:
with major abdominal surgery namely colectomy, cholecystectomy & intestinal perforation closure.
undergone general anesthesia.
age group between 21 to 60 years.
who are all able to chew the chewing gum.
who are alert, conscious and oriented.
who are willing to participate in the study.
who communicate in tamil.
Exclusion criteria
Previous history of allergic to chewing gum.
Colostomy surgery
With immediate post operative and post anasthesia complications.
Sample size
Total sample size was 60. In that experimental group - 30 & control group - 30
DESCRIPTION OF THE TOOL
The instrument was developed by the investigator with the help of expert opinions, various resources and review of literature.
The instrument comprised of 2 sections:
Section A - Demographic variables
Section B - Observation checklist to assess the bowel motility
Section A
It consists of demographic variables of the clients such as age, sex, type of surgery, operative diagnosis, duration of surgery, time of ambulation and previous bowel habits.
Section B
The observation checklist consists of hours of administration of chewing gum, hours of auscultation, peristaltic movement, passing of gas and defecation.
VALIDITY AND RELIABILITY OF THE TOOL
In this study seven experts validated the tool. The tool was evaluated for appropriateness, adequacy, relevance, completeness and appropriateness. Comments and suggestions were invited and appropriate modifications were made accordingly. The tool was refined and finalized after establishing the validity.
The reliability of the tool was elicted by test retest method.
DATA COLLECTION PROCEDURE
The data was collected among the clients undergone major abdominal surgery in Government Rajaji Hospital, Madurai. Written permission was sought and obtained from the authorites concerned. The period of data collection was six weeks. Sixty clients was selected for the study with above mentioned criteria. In that thirty clients are in experimental group and thirty are in control group. Initially good rapport was maintained with the clients and the purpose of the study was explained to them. In expeprimental group chewing gum was given on the first postoperative day onwards(25th hour of the surgery). Chewing gum was given three times per day(8 hours interval) for 20minutes until the 1st defecation. Every 4th hourly the bowel movements can be assessed by placing the stethoscope in each 4 quadrents of the abdomen for 3-5 minutes. Passing of gas and defecation will be obtained from the client subjectively. The average time taken for the interview was five minutes and each observation tooks seven minutes. In control group same procedure followed except the administration of chewing gum. All the clients were very cooperative and investigator expressed his gratitude for their cooperation.
PLAN FOR DATA ANALYSIS
The data analysis is the systemic organization and synthesis of research data and resting hypothesis. It involves the translation of information in to interpretable and managing form. The data obtained was analysed by using both descriptive and inferential statistics.
PILOT STUDY
The pilot study was conducted among six clients with major abdominal surgery in Shree Sathya Subha Hospital, Dindigul after obtaining formal permission from the authorities. In that 3 of them in control group and 3 of them in experimental group. The effectiveness of the chewing gum therapy was elicited by 't' test method and the result for peristaltic sound was 7.001, for passing of gas was 7.022 and for defecation was 7.333. All the values of the bowel motility was significant. And there may be the significant association between all the demographic variables and the bowel motility.
PROTECTION OF HUMAN RIGHTS
The proposed study was conducted after the approval of dissertation committee of the college. Permission was obtained from the Dean of Hospital and the Surgery department HOD of Government Rajaji Hospital, Madurai. Oral consent of each subjects were obtained before starting the data collection. Assurance was given to them that the anonymity of each individual would be maintained.
DATA ANALYSIS AND INTERPRETATION
This chapter deals with the description of the sample analysis and interpretation of the data collected from the clients undergone major abdominal surgery. The collected data were tabulated, analysed and presented based on the objectives and the hypothesis by using descriptive and inferential statistics.
The objectives in the study were,
To assess the level of bowel motility among clients undergone major abdominal surgery in control group.
To assess the level of bowel motility after administering chewing gum among clients undergone major abdominal surgery in experimental group.
To findout the difference in the level of bowel motility between experimental and control group.
To associate the relationship between the level of bowel motility and selected demographic variables among clients undergone major abdominal surgery.
The findings of the study were presented in the following headings,
Frequency and distribution of demographic variables of the clients undergone major abdominal surgery.
Mean, standard deviation, mean difference, and t-test of bowel motility of the clients underwent major abdominal surgery.
Chi square test of the demographic variables and bowel motility.
FIGURE 2
DISTRIBUTION OF CLIENTS BASED ON THE AGE GROUP
Age
Percentage
The figure 2 shows that among 60 clients interviewed majority 12(40%) of clients between 31-40 years in experimental group and 10(33.33%) of the clients between 41-50 years in control group.
FIGURE 3
DISTRIBUTION OF CLIENTS BASED ON THE SEX
Percentage
Sex
Figure 3 shows that regard to sex 15(50%) of the clients were male and female in experimental group and majority 19(63.33%) were male in the control group.
FIGURE 4
DISTRIBUTION OF CLIENTS BASED ON THE TYPE OF SURGERY
Percentage
Type of surgery
Figure 4 shows that regard to the type of surgery majority 15(50%) of the clients were underwent emergency surgery in experimental group and majority 16(53.33%) were undergone emergency surgery in control group.
FIGURE 5
DISTRIBUTION OF CLIENTS BASED ON THE OPERATIVE DIAGNOSIS
Percentage
Name of the surgery
Figure 5 shows that regarding operative diagnosis majority 13(43.33%) of clients undergone hemicolectemy surgery in experimental group and majority 14(46.33%) of clients undergone intestinal perforation closure surgery in control group.
FIGURE 6
DISTRIBUTION OF CLIENTS BASED ON THE DURATION OF SURGERY
Percentage
Duration of the surgery
Figure 6 shows that regarding the duration of surgery majority 28(93.33%) of syrgery finished with in 1-2hours in experimental and control group.
FIGURE 7
DISTRIBUTION OF CLIENTS BASED ON THE TIME OF AMBULATION
Percentage
Time of ambulation
Figure 7 shows that regarding time of ambulation majority 24(80%) of ambulation held <16hours in experimental group and majority 20(66.66%) of ambulation held in <16 hours in control group.
FIGURE 8
DISTRIBUTION OF CLIENTS BASED ON THE PREVIOUS BOWEL HABITS
Percentage
Previous Bowel Habits
Figure 8 shows that regarding the previous bowel habits majority 24(80%) of clients had normal in experimental group and majority 19(63.33%) of clients had normal bowel habits in control group.
TABLE 1
MEAN, STANDARD DEVIATION, MEAN DIFFERENCE, AND 't' -TEST OF BOWEL MOTILITY OF THE CLIENTS UNDERGONE MAJOR ABDOMINAL SURGERY.
n=60
BOWEL MOTILITY
MEAN
SD
MD
't'
1.Peristaltic sound
Experimental(n=30)
control(n=30)
45.1333
55.4000
4.39226
5.51862
10.26667
7.973
(0.010)
*
2.Passing of gas
Experimental(n=30)
control(n=30)
54.3333
65.0000
5.31318
5.4207
10.66667
7.697
(0.010)
*
3.Defecation
Experimental(n=30)
control(n=30)
81.4333
98.6667
9.56532
7.99281
17.23333
7.572
(0.010)
*
* -Significant
The table 1 reveals , the obtained 't' value was significant through the experimental and control group. The mean value of peristaltic movement in the experimental group was 45.13333 and in the control group was 55.4000. This indicates the mean difference between the experimental and control group was 10.26667 was a true difference and had not occurred by chance. Thus the obtained 't' value 7.973 is significant at 0.010 level.
The mean value of passing of gas in the experimental group was 54.3333 and in the control group was 65.0000. This indicates the mean difference between the experimental and control group was 10.66667 was a true difference and had not occurred by chance. Thus the obtained 't' value 7.697 is significant at 0.010 level.
The mean value of defecation in the experimental group was 81.4333 and in the control group was 98.6667. This indicates the mean difference between the experimental and control group was 17.23333 was a true difference and had not occurred by chance. Thus the obtained 't' value 7.572 is significant at 0.010 level.
It reveals that in experimental group the bowel motility mean time was decreased. So earlier bowel motility was achieved in experimental group.
TABLE 2
CHI SQUARE TEST OF THE DEMOGRAPHIC VARIABLES AND BOWEL MOTILITY
Demographic variables
Above mean
Below mean
Chi square
Age
26
34
16.8091
df=3
S
Sex
25
35
0.94032
df=1
NS
Type of surgery
25
35
1.0095
df=1
NS
Operative diagnosis
25
35
9.8561
df=2
S
Duration of surgery
25
35
6.0015
df=1
S
Time of ambulation
25
35
13.736
Df=2
S
Previous bowel habits
25
35
5.18009
df=1
S
*-Significant #-Nonsignificant df-degrees of freedom
Table 2 shows that the obtained chi-square value 16.8091 (P>0.05) showed significant association between the age and the peristaltic movement.
The obtained chi-square value 0.94032 (P>0.05) showed no significant association between the sex and the peristaltic movement.
The obtained chi-square value 1.0095 (P>0.05) showed no significant association between the type of surgery and the peristaltic movement.
The obtained chi-square value 9.8561 (P>0.05) showed significant association between the operative diagnosis and the peristaltic movement.
The obtained chi-square value 6.0015 (P>0.05) showed significant association between the duration of the surgery and the peristaltic movement.
The obtained chi-square value 13.736 (P>0.05) showed significant association between the time of ambulation and the peristaltic movement.
The obtained chi-square value 5.18009 (P>0.05) showed significant association between the previous bowel habits and the peristaltic movement.
It reveals that most of the demographic variables are signigicant with the peristaltic movement.
CHAPTER V
DISCUSSION
This chapter deals with the discussion and interpretation of the findings to evaluate the effectiveness of chewing gum therapy among clients undergone major abdominal surgery.
The discussion was based on the objectives specified in this study.
Objective : 1
To assess the level of bowel motility among clients undergone major abdominal surgery in control group.
Mean hours of peristaltic sound in control group was 55.4000, mean hours of passing of gas in control group was 65.000, mean hours of defecation in control group was 98.6667
This study was also supported by Cavusoglu.Y.H, et.al,(2008) a prospective, randomized, controlled trial on chewing gum prevents the onset of paralytic ileus in Dr.Sami ulus hospital, Turkey. The time to first flatus was 42.00±20.77 h in the control group (p=0.347). The time to first bowel movement was 56 63.00±26.34 in the control group (p=0.444). The length of hospital stay was 6.67±0.98 days for the control group (p=0.005).
This study was supported by Kafali.H, Duvan, et.al,(2009), a study on influence of gum chewing on postoperative bowel activity after cesarean section in Fatih University Medical School, Turkey. Results are bowel sounds appeared in a significantly shorter duration of time in the study group, the mean being 6.7 h in the control group (p < 0.01). The first passage of flatus postoperatively was 31 h in the control group (p < 0.001). The total length of hospital stay was shorter in the control group (2.3 days), but it was not statistically significant (p > 0.05).
This study was also supported by Schuster.R, Grewal.N,et.al,(2009), conducted a study on gum chewing reduces ileus after elective open sigmoid colectomy. The first passage of flatus occurred on postoperative hour 80.2 in the control group (P = .05). The first bowel movement occurred on postoperative hour 89.4 in the control group (P = .04). The first feelings of hunger were felt on postoperative hour 72.8 in the control group (P = .27). There were no major complications in either group.
It confirms that the bowel motility time in the control group was increased.
Objective : 2
To assess the level of bowel motility after administering chewing gum among clients undergone major abdominal surgery in experimental group.
Mean hours of peristaltic sound in experimental group was 45.1333, mean hours of passing of gas in experimental group was 54.33333, mean hours of defecation in experimental group was 81.4333
This study was supported by Kafali.H, Duvan, et.al,(2009), a study on influence of gum chewing on postoperative bowel activity after cesarean section in Fatih University Medical School, Turkey. Results are bowel sounds appeared in a significantly shorter duration of time in the study group, the mean being 5.9 h (p < 0.01). The first passage of flatus postoperatively was 22.4 h in the gum-chewing group (p < 0.001). The total length of hospital stay was shorter in the gum-chewing group (2.1 days).
This study was also supported by Cavusoglu.Y.H, et.al,(2008) a prospective, randomized, controlled trial on chewing gum prevents the onset of paralytic ileus in Dr.Sami ulus hospital, Turkey. The time to first flatus was 35.73±14.67 h in the gum-chewing group (p=0.347). The time to first bowel movement was 56.27±22.14 h in the gum-chewing group (p=0.444). The length of hospital stay was 5.80±0.68 days for the gum-chewing group and 6.67±0.98 days (p=0.005).
This study was also supported by Schuster.R, Grewal.N,et.al,(2009), conducted a study on gum chewing reduces ileus after elective open sigmoid colectomy. Prospective, randomized study was conducted in a community-based teaching hospital. The first passage of flatus occurred on postoperative hour 65.4 in the gum-chewing group (P = .05). The first bowel movement occurred on postoperative hour 63.2 in the gum-chewing group (P = .04). The first feelings of hunger were felt on postoperative hour 63.5 in the gum-chewing group (P = .27).
It confirms that the bowel motility time in the experimental group was decreased.
Objective : 3
To findout the difference in the level of bowel motility between experimental and control group.
Mean difference of peristaltic sound in experimental and control group was 10.26667 & 't' test value was 7.93, mean difference of passing of gas in experimental and control group was 10.66667 & 't' test value was 7.697, mean difference of defecation in experimental and control group was 17.23333 & 't' test value was 7.572. All the 't' test values were significant.
This study was supported by Chan M.K, Law W.L, (2008), a study on use of chewing gum in reducing postoperative ileus after elective colorectal resection in Caritas Medical Centre, Hong Kong SAR, China. Seventy-eight patients received an addition of gum chewing and 80 had standard postoperative care for colorectal resection. All patients tolerated the gum without any side-effects. With combined standard postoperative care and gum chewing, the patients passed flatus 24.3 percent earlier (weighted mean difference, -20.8 hours; P = 0.0006) and had bowel movement 32.7 percent earlier (weighted mean difference, -33.3 hours; P = 0.0002). So the use of gum chewing in the postoperative period is a safe method to stimulate bowel motility and reduce ileus after colorectal surgery.
This study was also supported by Zhang.Q, Zhao.P.(2009), a study on influence of gum chewing on return of gastrointestinal function after gastric abdominal surgery in children in Beijing Children's Hospital, china. The first passage of flatus in the gum-chewing group was seen on average of 69 h after operation, which was significantly earlier than the average of 77 h in the control group (p < 0.05). However, in contrast to the time of first flatus, the values of blood catecholamines and gastrin showed no significant difference between the two groups. Gum chewing hastens the return of intestinal function after gastric abdominal surgery in children.
It confirms that the bowel motility time difference between the experimental and control group was nearly 10 and 17 hours. So the gum chewing is the effective method to increase the bowel motility after the major abdominal surgery.
Objective : 4
To associate the relationship between the level of bowel motility and selected demographic variables among clients undergone major abdominal surgery.
Regarding the association between the age, operative diagnosis, duration of surgery, time of ambulation, previous bowel habits and the peristaltic movement shows significant association. Sex, type of surgery and peristaltic movement shows no significant association between them.
CHAPTER VI
SUMMARY,CONCLUSION, IMPLICATIONS AND RECOMMENDATIONS
The essence of any research project lies in reporting the findings. This chapter gives a brief account of the present study, along with the conclusion drawn from the findings, nursing implications, and recommendation for further studies.
SUMMARY
The focus of the present study was to assess the effectiveness of chewing gum in increasing the bowel motility among clients undergone major abdominal surgery. This study was carried with following objectives,
OBJECTIVES
To assess the level of bowel motility among clients undergone major abdominal surgery in control group.
To assess the level of bowel motility after administering chewing gum among clients undergone major abdominal surgery in experimental group.
To findout the difference in the level of bowel motility between experimental and control group.
To associate the relationship between the level of bowel motility and selected demographic variables among clients undergone major abdominal surgery.
NULL HYPHOTHESIS
Ho1 : There will be no association between the chewing gum and bowel motility among clients undergone major abdominal surgery .
Ho2 : There will be no significant association between the bowel motility with selected demographic variables after administering the chewing gum.
The investigator organized the review of literature under the following headings,
Review related to postoperative paralytic ileus
Review related to gum chewing
Review related to gum chewing and postoperative paralytic ileus
In methodology the research design selected for this study was quasi experimental with control group only post test design was used.
The study was conducted in Government Rajaji Hospital, Madurai. The population of the study was clients undergone major abdominal surgery. Purposive sampling technique was used to select the 60 samples in that 30 in control group and 30 in experimental group. Data collection tool include the interview schedule and observation checklist for assessing the bowel motility. The tool was given to seven experts for content validity and reliability was tested by using the 't' test method. Pilot study was conducted on 6 clients to findout the fecibility of the study. In experimental group chewing gum given 3 times a day for 20 minutes until the 1st defecation and the bowel motility assessed every 4th hourly. In control group they assessed for bowel motility until the 1st defecation. Data were analyzed using descriptive and inferential statistics. The data was presented using tables and graphs.
SUMMARY OF THE STUDY FINDINGS
Objective 1: To assess the level of bowel motility among clients undergone major abdominal surgery in control group.
Mean hours of peristaltic sound in control group was 55.4000, mean hours of passing of gas in control group was 65.000, mean hours of defecation in control group was 98.6667
Objective 2: To assess the level of bowel motility after administering chewing gum among clients undergone major abdominal surgery in experimental group.
Mean hours of peristaltic sound in experimental group was 45.1333, mean hours of passing of gas in experimental group was 54.33333, mean hours of defecation in experimental group was 81.4333
Objective 3: To findout the difference in the level of bowel motility between experimental and control group.
Mean difference of peristaltic sound in experimental and control group was 10.26667, mean difference of passing of gas in experimental and control group was 10.66667, mean difference of defecation in experimental and control group was 17.23333
Objective 4: To associate the relationship between the level of bowel motility and selected demographic variables among clients undergone major abdominal surgery.
Regarding the association between the age, operative diagnosis,, duration of surgery, time of ambulation, previous bowel habits and the peristaltic movement shows significant sssociation. Sex, type of surgery and peristaltic movement shows no significant association between them.
CONCLUSION
The following conclusions were drawn from the study,
Chewing gum after major abdominal surgery is a simple and effective method to treat postoperative paralytic ileus. Chewing gum aids early recovery from postoperative paralytic ileus and is an inexpensive, simple, effective and physiologic measure for promoting the bowel function. Gum chewing should added as an adjuant treatment in postoperative care because it might contribute to hasten the return of gastrointestinal function after abdominal surgery. Therefore nurses working in postoperative war should encourage clients to chew chewing gum after major abdominal surgery.
IMPLICATIONS
The implications of the findings had been discussed in relation to nursing service, nursing education, nursing administration and nursing research.
Implication of nursing practice
Chewing gum can reduce the occurrence of postoperative paralytic ileus. Nurse can use this therapy as a effective measure to treat postoperative paralytic ileus.
Administration of chewing gum can proived mouth freshness to the postoperative clients.
Chewing gum can reduces the mental stress and provides relaxation to the postoperative clients.
Chewing gum serves as a divertional activity too.
Implications of nursing research
Study will be the valuable reference and pathway for further researchers.
The findings of the study would help to expand the scientific body of professionl knowledge upon which further research can be conducted.
Administration of chewing gum may be studied more significantly and used specific nursing intervention.
Implications of nursing education
The results of the study was used as illustration to students by their nursing teachers.
It help nursing students to plan and organize the nursing intervention to prevent the postoperative paralytic ileus with complementry therapies.
Periodic conference, seminars, and soymposiun can arranged regarding alternative and complementry therapies to make nursing professional competent to meet the every changing needs of the society.
Implications of nursing administration
The nurse administrator should take more responsibility to implement a protocol of chewing gum therapy/alternative therapies as to prevent postoperative paralytic ileus.
Administrator should motivate the staff for effective increasing the bowel motility which should help in faster recovery, preventing complications and there by provide cost effective care to the clients.
The nurse administrator should organize in service education about complementry and alternative therpies and adequate reading material to refresh their knowledge and get acquainted with newer techniques.
LIMITATION
The study had following limitations,
Random selection was not done.
Blinding could have avoided investigator bias.
Study was limited to only laporotomy surgery.
Study was done on limited sample.
Experience level of investigator.
Assessment for findings was done only 4th hourly.
RECOMMANDATIONS
A similar study may be repeated for more generalization of finding.
A similar study can be done on large sample.
Study can be repeated in different setting to strengthen the finding.
A longer period of intervention can be studied for more reliability effectiveness.
