Return of Bowel Sounds

Indicating An End of
Postoperative Ileus: Is it Time
to Cease this Long-Standing
Nursing Tradition?
Author: Robert L. Massey
Jeanine M. Diaz
Essentials of Nursing Research
NUR 322
Research Problem
 Current nursing practice relies
on the return of bowel sounds
after abdominal surgery as a
reliable indicator to the
resolution of post operative
ileus (POI)
 Evidence-based inquiry
questions the effectiveness
 Is auscultating bowel sounds a
reliable indicator of the return
of GI motility and thus an end
to POI in post abdominal
surgery patients?
Other Methods May be More Effective
 Evidence supports passage of first
flatus as an effective indicator of
the return of GI motility
 Previous research does not
compare return of bowel sounds
to a specific indicator
 Absence of abdominal distention,
nausea, vomiting, pain, and the
ability to tolerate a diet are other
parameters that can indicate the
resolution of POI and may be
more reliable
Significance of the Problem
 Postoperative ileus occurs  POI can last 3-5 days and can
universally following add to the length of the
abdominal surgery average hospital stay adding
billions of dollars to health
 Patients experience a
care costs yearly
symptom cluster including:
nausea, vomiting, abdominal
distention, diet intolerance,
and pain
 Patients report this symptom
cluster as the most
uncomfortable part of
abdominal surgery recovery
Study Purpose Additional Aims
of the Study
Overall

 To provide evidence and  To determine an

rationale supporting association between
evidence-based inquiry return of bowel sounds
questioning the and passage of first
effectiveness of return of postoperative flatus
bowel sounds as a  To determine if a rocking
reliable indicator of the chair motion reduces the
end of POI post duration of POI
abdominal surgery
What Does This Mean for
Nursing Practice?
 Auscultation of return of bowel sounds as an indication
for the end of POI has been used since 1905
 Therefore if evidence is found to support this method as
an unreliable indication to the resolution of POI and no
correlation exists between return of bowel sounds and
the first postoperative flatus, nurses may need to change
this long-standing tradition
 If a rocking chair motion is found to reduce the duration
and effects of POI, this intervention can be used in
nursing practice
Study Design
 Two-group, post-test only, randomly assigned study
 Iowa Model of Evidence Based Practice
 The independent variable of the study was the rocking
chair used which is also the intervention
 The Dependent variable of the study is the reduction of
the duration and effects of POI
 No specific mention of a theoretical framework used
Study Sample
 Sixty-six patients were conveniently chosen from the Cancer
center and were randomized to the control or rocking group
 Inclusions included patients with digestive system cancers
scheduled for abdominal surgery, English speaking,
cognitively intact, able to ambulate and sit in rocking chair,
and capable of receiving patient-controlled intravenous or
epidural analgesia
 No mention of exclusion criteria
 Approval was obtained from the University of Texas MD
Anderson Cancer Center Institutional Review Board (IRB)
before the study began
 Signed consent was obtained from willing participants
Data Collection Procedure
 Approval obtained from the University of Texas MD Anderson Cancer
Center IRB
 Informed consent obtained from patients prior to surgery who met eligibility
criteria
 Selected participants interviewed by research team members and
provided an explanation of the study’s purpose, as well as allotted time for
question inquiry
 Signed consent obtained from those choosing to participate
 Patients randomized to control or rocking chair group before they began
surgery
 Data collection started during first postoperative day by the primary
investigator, and included assessing patients each morning at the same
time for return of bowel sounds and passage of first flatus
 Patient’s records reviewed each day for recording of return of bowel
sounds or first flatus by other health care team members
 Findings were documented on a study data sheet
Results
 No significant difference between the rocking (M=2.21,
SD=0.48) and non-rocking (M=2.25, SD 0.50) groups in the
time to first bowel sounds between the two groups (t
(64)=0.363, p=0.718, p<0.05)
 No correlation was found between return of bowel
sounds and time to first flatus as times were not
significant (r=0.231, p=0.062)

M(Massey, 2012)
Study Limitations
 No study limitations were mentioned by the researcher
 No power analysis was done to determine if the sample
size was big enough to achieve adequate power
 Sample size may not be big enough to generalize the
findings to the larger population
 Very Specific inclusion criteria and use of only one
setting
 Little time for data collection
Implication for Nursing
Practice/ Conclusion
 The long-standing nursing tradition of auscultating for the
return of bowel sounds to determine the end of POI and
return of GI motility post abdominal surgery may need to
be replaced with more reliable indicators
 More research needs to be done to determine if
resolution of the symptom cluster including: abdominal
distention, nausea, vomiting, and diet intolerance, as
well as the first passage of flatus are more reliable
indicators for nurses to assess for the resolution of POI
 Until then, nurses should use the return of bowel sounds
as the indicator to the end of POI with caution
 References

 Fain, J. A. (2015). Reading, understanding, and applying nursing research.

Philadelphia, PA: F.A. Davis.

 Massey, R. (2012). Return of bowel sounds indicating an end of

postoperative ileus: Is it time to cease this long-standing nursing

tradition? Medsurg Nursing, 21(3), 146-150.

 Rempher, K. (2008). Making sense of statistical power. American Nurse Today, 3(6).

Retrieved from https://www.americannursetoday.com/making-sense-of-statistical-

power/.