Searching for the Evidence on Chewing Gum After Abdominal Surgery: A Documented Search Across Three Databases
Student Name
American College of Education
NUR4053: Research Methods and Evidence-Based Practice in Nursing
Module 2 Assignment
Instructor Name
July 13, 2026
The Question Being Searched
Patients on the surgical unit where I work, a 30-bed unit that receives mainly colorectal and gynecologic surgery patients, often ask when they can eat, and the answer depends partly on when bowel function returns. Several surgeons on the unit now write orders allowing patients to chew sugar-free gum after surgery, while others do not, and nurses are unsure whether the practice makes a measurable difference. This unit, and the way it works, is a composite drawn for the assignment.
The question for this search, in PICOT form, is: In adults recovering from abdominal surgery (P), does chewing gum after surgery (I), compared with no gum (C), lead to earlier first flatus and bowel movement and a shorter hospital stay (O) during the postoperative hospital stay (T)? It is an intervention question, so the search aims first for systematic reviews and randomized controlled trials. A documented search begins with the question written down, because every later decision about terms and limits has to be traceable to one of its elements.
Databases and Search Strings
Three databases were searched on July 8, 2026. CINAHL Complete was chosen because it indexes nursing journals and nursing-led postoperative studies that may not appear elsewhere. PubMed, which searches MEDLINE, was chosen for its coverage of surgical and gastroenterology journals, where most gum-chewing trials are published. The Cochrane Library was searched for systematic reviews, since a review on this exact question would be the strongest single source. A final pass through Google Scholar served only as a safety net for missed items, since its result lists shift from one day to the next and cannot be reproduced.
Each search string was built from the question's elements. The intervention was searched as chewing gum OR gum chewing OR sham feeding, because some trials describe gum as a form of sham feeding. The outcome was searched as ileus OR postoperative ileus OR bowel function OR flatus OR length of stay. The population term was abdominal surgery OR colorectal surgery OR cesarean OR laparotomy. The three groups were joined with AND. In PubMed, the Medical Subject Heading Chewing Gum was added to the intervention group, and in CINAHL the subject heading Postoperative Ileus was added to the outcome group, because subject headings capture articles that use unexpected words in their titles.
The comparison element, no gum, was not searched as a term, since trials describe their control groups in many different ways and adding the term would have excluded relevant studies. Leaving an element out of the search string on purpose, and saying so, is different from forgetting it.
Limits and Counts at Each Stage
In PubMed, the combined search returned 312 records. Limiting to English language reduced the total to 289, and limiting to adults aged 19 and older reduced it to 214. The date limit was set to the previous fifteen years rather than five, because the landmark trials and the most recent Cochrane review fall inside that window and a five-year limit would have excluded them; that left 161 records. Keeping only trials, systematic reviews and meta-analyses through the article-type filter brought the set down to 74. In CINAHL, the same approach gave 96 records at the start and 31 after limits. The Cochrane Library search returned one directly relevant review and 58 trial records in its central register, most of which duplicated the PubMed results.
Titles and abstracts of the 105 records remaining across PubMed and CINAHL were screened, and 41 duplicates were removed first. Of the remaining 64, 47 were excluded because they studied a different population, such as children, or a different intervention, such as coffee or early feeding alone, or because they were conference abstracts without full reports. The full texts of 17 articles were read, and 9 were kept for the next module's appraisal. These counts are specific to the date of the search and would change if it were repeated, which is why the date is recorded.
Primary Reports and Summaries
The sources kept fall into four types, and they are not interchangeable. The most important is a systematic review. Short et al. (2015) reviewed 81 randomized trials with 9,072 participants and found that chewing gum reduced the time to first flatus by about 10 hours and the time to first bowel movement by about 13 hours, and shortened hospital stay by a little under one day, with the largest effects after colorectal surgery and the smallest after cesarean birth. They also rated many of the included trials at high or unclear risk of bias. A review like this is a summary, but a systematic one: its methods are published, it can be checked and it is the strongest evidence for an intervention question.
The second type is the primary trial. One colorectal trial randomized 120 patients to chewing gum or a control and found postoperative ileus in 27 percent of the gum group against 48 percent of controls, while the difference in length of stay did not reach statistical significance (van den Heijkant et al., 2015). Shang et al. (2010) randomized women after cesarean birth and reported a slight improvement in early recovery with gum. Primary reports give the details a review compresses: who was studied, how outcomes were measured and what the control group actually received.
The third type is a guideline. The Enhanced Recovery After Surgery Society's colorectal guideline (Gustafsson et al., 2019) addresses gum chewing among its recommendations for preventing postoperative ileus. A guideline is a summary built on reviews and trials plus expert judgment, and it tells a unit what is considered reasonable practice. The fourth type, several short professional magazine articles describing gum chewing as best practice, were set aside. They were secondary summaries that cited one or two trials each, and none added information that the review and the trials did not already provide.
Limits of This Search
Every search has boundaries, and stating them is part of documenting it. Limiting results to English-language publications excluded 23 PubMed records, several of them trials from China and Iran, where much of the cesarean research on gum chewing has been done; the Cochrane review includes some of these trials, which partly offsets the loss. Restricting to adults removed pediatric surgery studies, which is appropriate for this unit but means the findings should not be applied to children. No search was made of trial registries for unpublished studies, so the results may lean toward trials that found a benefit, a problem the review itself notes when it discusses the quality of the included trials.
The search also depended on the terms chosen. A trial that described gum chewing only as a form of early oral stimulation, without using the words chewing gum or sham feeding, could have been missed despite the subject headings. Running a second search with the terms oral stimulation and postoperative recovery, or asking a health sciences librarian to review the strings, would reduce that risk before the evidence is used to change unit practice. A search that names its own blind spots is more trustworthy than one that claims to have found everything.
Conclusion
The search found a large systematic review, several primary trials and a current guideline that together bear directly on the question, and it did so through a process another nurse could repeat. Recording the databases, strings, limits and counts took longer than typing a phrase into a search engine, but it produced a smaller, better set of sources and a record of every decision along the way. The next module will appraise the nine sources kept, starting with the review and the colorectal trial, to decide whether the evidence supports a unit-wide practice rather than a surgeon-by-surgeon one.
References
Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., Rockall, T. A., Young-Fadok, T. M., Hill, A. G., Soop, M., de Boer, H. D., Urman, R. D., Chang, G. J., Fichera, A., Kessler, H., Grass, F., Whang, E. E., Fawcett, W. J., Carli, F., . . . Ljungqvist, O. (2019). Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations: 2018. World Journal of Surgery, 43(3), 659-695. https://doi.org/10.1007/s00268-018-4844-y
Shang, H., Yang, Y., Tong, X., Zhang, L., Fang, A., & Hong, L. (2010). Gum chewing slightly enhances early recovery from postoperative ileus after cesarean section: Results of a prospective, randomized, controlled trial. American Journal of Perinatology, 27(5), 387-391. https://doi.org/10.1055/s-0029-1243313
Short, V., Herbert, G., Perry, R., Atkinson, C., Ness, A. R., Penfold, C., Thomas, S., Andersen, H. K., & Lewis, S. J. (2015). Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database of Systematic Reviews, 2015(2), Article CD006506. https://doi.org/10.1002/14651858.CD006506.pub3
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., Hulsewe, K. W. E., de Jonge, W. J., Buurman, W. A., & 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. https://doi.org/10.1002/bjs.9691
How this NUR 4053 Module 2 example is structured
NUR 4053 Module 2 often covers searching: databases, terms, limits and telling a primary report from a summary; your classroom's instructions decide whether a search log, a narrative or both are required. This example states the question first, explains the choice of databases, shows the search strings built from the question's elements, and reports each limit with the number of records before and after it. It then classifies the sources kept into systematic review, primary trials, guideline and professional summary, and explains what each type can and cannot contribute. That order lets a grader repeat the search, which is the standard a documented search is meant to meet.
NUR4053 Module 2 questions, answered
What does NUR4053 Module 2 usually ask for?
NUR4053 Module 2 often asks students to carry out and document a literature search for their clinical question: which databases were used, which terms and limits were applied, how many records were found at each stage and which sources were kept. Many sections also ask students to tell primary research from summaries. Your classroom's instructions decide the format and the number of sources required.
Which databases should a nursing student search?
CINAHL and PubMed are the standard pair for nursing questions, because together they cover nursing and medical journals. Add the Cochrane Library when the question is about an intervention, since it holds systematic reviews. Use Google Scholar only as a final check, because its results cannot be reproduced exactly. Your school library's database list shows what you can access.
What is the difference between a primary source and a summary?
A primary source reports original research, such as a randomized trial, written by the people who did it. A summary reports other people's research: systematic reviews, guidelines, textbooks and magazine articles. Systematic reviews are summaries with published methods and are often the strongest evidence; informal summaries should be traced back to the studies they cite.
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