الفهرس 
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Abstract
Summary
Chewing gum has emerged as a new and simple modality for decreasing POI. Gum chewing in the postoperative period is a safe method to stimulate bowel motility and it has been shown to reduce ileus and helps to resume early bowel functions normally.
Early mobilization may exert a mechanical stimulation of intestinal function. Generally it is believed that early mobilization aids in the restoration of normal bowel function, allow children to more easily pass flatus, stool and resume normal bowel habits. Children are encouraged to walk for their overall well-being but also in an effort to resolve more quickly ileus and to relieve the associated cramps and bloating.
It is role of the nurse to help children resolved early from post-operative ileus after abdominal surgery and assessed children for return of bowel motility.
This study aimed to determine the efficacy of chewing gum versus early mobilization on bowel motility for children after abdominal surgery.
This study was conducted at the pediatric surgery unit in Assiut University Children Hospital. The study subjects were including a convenience sample of 90 children from 6 to 18 years after abdominal surgery. They were divided in to three groups with the same type of surgery: group I chewing gum, group II for early mobilization and group III control group received no intervention.
Tools of the study
Four tools were used to collect the required data:
Tool I: A structure questionnaire:
It was developed by the researcher to collect the required information and included three parts:
Part (1): Personal data of the studied children as (age and gender)
Part (2): Personal data of the studied children’s mothers as (age, educational level and occupation)
Part (3): Medical data related to child’s surgery (types of abdominal surgery, indication of abdominal surgery as emergency or elective, hospital stay before surgery, type of anaesthesia and duration of surgery).
Tool II: Chewing gum sheet:
It was developed by the researcher to monitor time of starting chewing gum, duration of chewing gum and time of passage of first flatus after chewing gum.
Tool III: Child’s mobilization sheet:
It was developed by the researcher based on the study by Fiore et al., 2017 and included the following: when the child dangled their legs, standed beside the bed and started to walk for the first time, duration of walking session and its frequency per day, total hours per day the child stayed outside the bed included sit in the chair.
Tool IV: Bowel motility monitoring sheet:
It was developed by the researcher based on the study by Jaimez, 2012 and was included the following information: time to first flatus, time to first passage of stool, time to tolerate feedings (oral intake) and post-operative hospital stay.
Method of data collection
• Research proposal was approved from Ethical Committee in the faculty of Nursing.
• An official permission was obtained from the director of pediatric surgery unit in Assiut university children hospital to collect the necessary data for this study.
• Apilot study was carried out on 10% of children to test the clarity and applicability of the sheet and to estimate time needed to fulfill each sheet. There were no modification done so, the children were included in the total sample of the study.
• Tool I, Tool II, Tool III & Tool IV were developed by the researcher and were tested for its contents validity index by 5 experts in both pediatric nursing and pediatric surgery fields and it was was 0.96 for tool I, 0.98 for tool II 0.98 for tool III and 0.97 for tool IV.
• The reliability of the tools was elicited by alpha Cronbach test and it was 0.854 for tool II, 0.862 for tool III and 0.841 for tool IV.
Main results of this study revealed that:
• It was found that (56.7%) of the chewing gum group, (43.3%) of the early mobilization group and (30%) of the control group return of their bowel sound during 12-<24 hrs
• Time to return of bowel sound, passage of first flatus, first feces, return of appetite, time of liquid diet and regular diet were statistically significant difference in the chewing gum group while only time to passage of first flatus and first feces were statistically significant difference in the early mobilization group.
Conclusion:
It was found that chewing gum was slightly more effective than early mobilization in improving bowel motility after abdominal surgery in children but the diffrerence was not statistically significant.
Recommendations:
1. Conducting a further study for evaluating the effect of chewing gum and early mobilization on postoperative ileus among abdominal surgery children using a larger sample and different geographical areas in Egypt.
2. Chewing gum and early mobilization should be incorporated as one of the post-operative ileus management modality in daily practice.
3. Educational programs should be provided to increase knowledge and skills for nurses in applying non-pharmacological intervention to improve bowel motility after abdominal surgery.