Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Joy Turner Washburn, EdD, RN, WHNP-BC

Second Advisor

Marie VanderKooi, DNP, RN

Third Advisor

Shelly Mouw, MSN, APRN, AGCNS-BC


Aims and objectives: The purpose of this project was to evaluate if the implementation of a chewing gum protocol improved bowel motility, decreased ileus rate, length of stay, bowel and pain medication use, and hospital costs in post-surgical spinal patients in a suburban hospital.

Background: Postoperative bowel dysfunction is a major source of health problems, including abdominal pain, ileus, increased length of stay, pain medication use, and healthcare costs.

Design: Retrospective cohort study with a focus on program evaluation of the previously implemented chewing gum protocol. An audit of the electronic health record compared outcomes in patients five months before the intervention (n=123) and after the intervention (n=128).

Methods: A retrospective, randomized audit of the electronic health record was conducted to evaluate 1/3rd of the surgical spinal patients before and after the initiation of a chewing gum protocol on a surgical spinal unit in a suburban hospital in the Midwest. Study variables were time to first stool, length of stay, ileus rate, pain and bowel medication use. Statistical analysis conducted using Mann-Whitney U tests.

Results: While no statistically significant difference identified among study variables, there were clinically significant decreases in ileus rate, median time to first stool, length of stay, and pain medication use post-implementation.

Conclusions: The evidence-based chewing gum protocol in this study indicated clinically significant decreases in pain medication use and ileus along with other small decreases in length of stay and time to first stool in post-surgical spinal patients. Despite lack of statistical significance, the protocol was a safe and inexpensive intervention that reduced patient care costs, with a total return on investment of $18,745.16.

Relevance to clinical practice: Chewing gum has potential to positively affect post-operative patient care outcomes as an inexpensive intervention to decrease pain medication use and promote bowel motility.

Available for download on Friday, May 03, 2024

Included in

Nursing Commons