Factors and Processes Facilitating Recovery from Coercion in Mental Health Services-A Meta-Ethnography.

BACKGROUND: Being subjected to or witnessing coercive measures in mental health services can have a negative impact on service users, carers and professionals, as they most often are experienced as dehumanising and traumatic. Coercion should be avoided, but when it does happen, it is important to understand how the experience can be processed so that its consequences are managed. METHOD: A systematic review and meta-ethnography was used to synthesise findings from qualitative studies that examined service users', staff's and relatives' experiences of recovery from being exposed to coercive measures in mental health care settings. We identified, extracted and synthesised, across 23 studies, the processes and factors that were interpreted as significant to process the experience. RESULTS: Recovery from coercion is dependent on a complex set of conditions that support a sense of dignity and respect, a feeling of safety and empowerment. Being in a facilitating environment, receiving appropriate information and having consistent reciprocal communication with staff are the means through which these conditions can be achieved. People employ strategies to achieve recovery, both during and after coercion, to minimise its impact and process the experience. CONCLUSIONS: The findings point to the importance of mental health care settings offering recovery-oriented environments and mental health professionals employing recovery-oriented practices, that would empower service users to develop strategies for managing their mental distress as well as their experiences in mental health care in a way that minimises traumatisation and fosters recovery.

Retrospective Investigation of Difficult Airway Cases Encountered in Bursa Uludag˘ University Medical Faculty Operating Room.

OBJECTIVE: Ensuring airway patency and proper management of ventilation by anticipating difficulties that can occur in airway control are vital in preventing anaesthesia-related complications. We aimed to determine the role of preoperative assessment findings in difficult airway management. METHODS: In this study, critical incident records of difficult airway patients between 2010 and 2020 in the operating room of Bursa Uludag˘ University Medical Faculty were retrospectively analysed. A total of 613 patients, whose records were fully accessible, were grouped as paediatric (under 18 years old) and adult (18 years and over). RESULTS: The success rate for maintaining an airway in all patients was 98.7%. Pathological situations which cause difficult airways were head and neck region malignancies in adult patients and congenital syndromes in paediatric patients. Anatomical reasons that cause difficult airway were anterior larynx (31.1%) and short muscular neck (29.7%) in adult patients and small chin (38.0%) in paediatric patients. A significant statistical relationship was found between difficult mask ventilation and increased body mass index, male gender, modified Mallampati class 3-4, and thyromental distance <6 cm (P = .001, P < .001, P < .001, and P < .001, respectively). The correlation of Cormack-Lehane grading with modified Mallampati classification, upper lip bite test, and mouth opening distance was statistically significant (P < .001, P < .001, and P < .001, respectively). CONCLUSION: In male patients with increased body mass index, modified Mallampati test class of 3-4 and thyromental distance of < 6 cm should suggest the possibility of difficult mask ventilation. In modified Mallampati classification and upper lip bite tests, the possibility of difficult laryngoscopy should be considered as class increases and mouth opening distance becomes shorter. Preoperative assessment, including a good history taken from the patient and a complete physical examination, is crucial to provide solutions for difficult airway management.

Trauma Recovery Rubric: A Mixed-Method Analysis of Trauma Recovery Pathways in Four Countries.

Research is beginning to examine gender-based violence (GBV) survivors' recovery, but little is known about diverse recovery trajectories or their relationships with other distress and recovery variables. This interdisciplinary, international multisite mixed-method study developed and used the TRR to identify and classify survivors' trauma pathways. This study describes the phases of the initial development of the preliminary TRR (Phase 1), refines and calibrates the TRR (Phase 2), and then integrates the TRR into quantitative data from four countries (Phase 3). Seven recovery pathways with six domains emerged: normalizing, minimizing, consumed/trapped; shutdown or frozen, surviving, seeking and fighting for integration; finding integration/equanimity. Depression scores were related to most recovery domains, and TRR scores had large effect sizes. At the same time, PTSD was not statistically related to TRR scores, but TRR had a medium effect size. Our study found that the TRR can be implemented in diverse cultural settings and promises a reliable cross-cultural tool. The TRR is a survivor-centered, trauma-informed way to understand different survivorship pathways and how different pathways impact health outcomes. Overall, this rubric provides a foundation for future study on differences in survivor healing and the drivers of these differences. This tool can potentially improve survivor care delivery and our understanding of how to meet best the needs of the survivor populations we intend to serve.

Adapting the Geriatric Institutional Assessment Profile for different countries and languages: A multi-language translation and content validation study.

BACKGROUND: Hospitalization can be hazardous for older people, but most hospitals in Europe are not prepared to meet the unique needs of older adult inpatients. Adaptations of the physical environment, care processes, and staff knowledge and skills in geriatric care are essential to improve the quality of care for older people. An assessment of baseline organizational approaches to older adult care is an important first step toward recognizing the challenges organizations face when delivering acute care services to older adults and attempting to improve them. The Geriatric Institutional Assessment Profile could be a promising tool for this endeavor. OBJECTIVES: To describe a systematic process implemented across seven countries and languages that sought to develop valid and culturally-appropriate translations of the Geriatric Institutional Assessment Profile. DESIGN: Cross-cultural instrument translation and content validation study. SETTING AND PARTICIPANTS: Expert review panels comprised of 68 practicing nurses from seven European or EU associated countries (Austria (German), Belgium (Dutch), Denmark (Danish), Israel (Hebrew), Poland (Polish), Switzerland (German, French), and Turkey (Turkish)) evaluated cross-cultural relevance, including translation, of the Geriatric Institutional Assessment Profile. METHOD: A systematic approach to translating and validating a cross-cultural survey instrument, including back-to-back translation, adaptation, and evaluation of content validity using content validity indexing (CVI) techniques for each country and language, assessing translation and relevance content validity separately. The item, subscale and domain content validity index scores were calculated and adjusted for chance agreement among raters for all parts of the Geriatric Institutional Assessment Profile: the four subscales of geriatric care environment, the general knowledge about older adults subscale, and the clinical geriatric knowledge subscale. Consensus discussions among the raters then finalized translations. RESULTS: CVI scores for relevance and translation were all in the "good" to "excellent" range. The geriatric care environment scale's CVI scores were 0.84 to 0.94 for relevance and 0.82 to 0.98 for translation. The clinical geriatric knowledge subscale's CVI scores were 0.83 to 0.97 for relevance and 0.94 to 0.98 for translation. The general knowledge about older adults subscale received high translation agreement (0.93 to 0.99) but slightly lower scores for relevance, ranging from 0.46 to 0.94. CONCLUSION: Study results provided preliminary evidence of the applicability and validity of a multi-factor measure of age-friendly care in diverse health care systems, in German, Dutch, Danish, Hebrew, Polish, French, and Turkish languages.

An examination of effects of intimate partner violence on children: A cross-sectional study conducted in a paediatric emergency unit in Turkey.

BACKGROUND: Intimate partner violence (IPV) against women causes inadequate and unbalanced nutrition in children aged 0-5 years and adversely affects their growth. AIM: To examine the impact of intimate partner violence on a child's growth regarding the medical diagnosis in paediatric patients under 5 years of age, growth of the child, and the mother's exposure to intimate partner violence. METHODS: This descriptive cross-sectional study included 166 children admitted to a paediatric emergency department, and their mothers. RESULTS: Women exposed to emotional violence and controlling behaviour during pregnancy had children prone to being overweight and obese. A mothers lifetime exposure to physical violence had an adverse effect on their children's wasting and moderate wasting. In contrast, mothers' exposure to emotional violence had a direct impact on a child's wasting and moderate wasting. CONCLUSION: The lifetime effect of domestic violence may begin at birth. This vulnerability leads to negative outcomes in both children and women regarding biopsychosocial development. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses and midwives in primary health care services and one-on-one care should be trained to evaluate prospective mothers and children aged 0-5 regarding violence and its effects on the child's growth.

The effectiveness of metacognitive training on impairments in social cognition in patients with schizophrenia: mental health nursing practice in a community mental health center.

BACKGROUND: Social cognition is an independent structure from the positive symptoms of schizophrenia and contributes to negative symptoms, neurocognitive impairment, and social functioning. AIM: To examine the effectiveness of the metacognitive training intervention on social cognition in people with schizophrenia. DESIGN: This study was conducted as a randomized quasi-experimental (pre-test/post-test and follow-up) design with a control group. METHODS: Thirty-nine patients with schizophrenia were enrolled and randomly assigned to either the control group (n = 19) or the metacognitive training group (n = 20). A 10-week metacognitive training program was offered to the intervention group. The study involved a pre-test/post-test design with a 3-month follow-up assessment. The primary outcome was social cognition, as measured by the Facial Emotion Discrimination/Identification Tests, Reading the Mind in the Eyes Test, and Attributional Style Questionnaire. The secondary outcome was measured by the metacognitive training subjective efficacy form. RESULTS: Completion at follow-up was high (92.3%). The results show that the changes over time in the False Belief Task 1st level, Attributional Style Questionnaire negative events global-specific dimension, and positive events stable-unstable dimension mean scores, time interaction, were statistically significant. Metacognitive Training was efficacious on the theory of mind and in performing more functional attributions. Patients in the intervention group showed high-level positive feedback. CONCLUSION: Metacognitive Training applied by psychiatric and mental health nurses demonstrated a user and practitioner-friendly, safe and effective program on social cognition. Also, the social and cultural feasibility and effectiveness of the Metacognitive Training program were shown for the first time in a Turkish population.

The moderating role of resilience in the relationship between peer pressure and risky behaviors among nursing students.

PURPOSE: To examine the moderating role of resilience in the relationship between peer pressure and risky behaviors among nursing students. DESIGN AND METHODS: A cross-sectional correlational study carried out with 512 students. FINDINGS: The mean age was 20.90 ± 1.66. Of the students, 82.4% were females 99.0% were single, 71.5% had moderate socioeconomic status. While peer pressure directly made an effect on whole subdimensions for risky behaviors (p < 0.001), resilience had an effect on antisocial behavior, dropout, eating habits, and suicidal tendency (p < 0.001). Moderation was supported as the relationship between peer pressure and substance use varied by resilience level (p < 0.001). PRACTICAL IMPLICATIONS: Students with high levels of resilience are less prone to exhibit some risky behaviors based on peer pressure. Resilience-building strategies should be incorporated into the curriculum.

Experiences of Minority Stress and Intimate Partner Violence Among Homosexual Women in Turkey.

Intimate partner violence (IPV) has been recognized as an important public health problem over the past two decades, and increased attention to violence in intimate relationships has been given to heterosexual couples. Although the vast majority of literature has determined the rate of IPV among lesbian, gay, bisexual couples, and relationship quality, few studies investigated how stress specific to living as a lesbian or bisexual woman might correlate with IPV in these relationships. For this reason, the purpose of this descriptive study was to determine the experiences of minority stress and IPV among homosexual women (n = 149) in Turkey. Data were collected using convenience and snowball sampling. Participants completed an interviewer-administered survey. Results indicated that victimization and perpetration of all the forms of IPV occur but the most prevalent was perpetration (66.4%) and victimization (63.1%) of psychological violence. The mean score of participants' total level of outness was found 4.78 ± 2.15 (0-10). Most participants (74.5%) reported being often exposed to discrimination in the public area and reported moderate level of internalized homophobia (2.72 ± 0.87). Participants' level of outness associated with psychological (Victimization r = .319, p = .00; Perpetration r = .421, p = .00), physical (Victimization r = .184, p = .025; Perpetration r = .209, p = .010), and sexual (Victimization r = .263, p = .001; Perpetration r = .372, p = .00) violence perpetration and victimization. It is also founded that there was relation between internalized homophobia level and sexual violence perpetration (r = .164, p = .045)/victimization (r = .189, p = .021). These findings demonstrate a need for health care staff to be aware of the prevalence of IPV and minority stress that affected this population. Mental health of homosexual individuals is under the risk due to minority stress and IPV experiences. Furthermore, this finding illustrated that need for additional empirical research improved interpersonal relationship among these women. Also, policies need to be developed to reduce the minority stress experienced by these individuals and provide integration with the society.

A retrospective examination of the content of violence in headlines of news related to individuals with mental disorders.

BACKGROUND: Headlines are usually read first. Since headlines are designed to be remarkable and memorable in terms of form and meaning, their impact on the positive or negative attitudes of the society towards individuals with mental illness may be greater than the news texts. AIMS: This study aimed to retrospectively examine and analyze the content of violence headlines related to people with mental disorders. METHOD: The study was designed to examine headlines retrospectively. Six-hundred-ten headlines on the websites of four nationally published newspapers in Turkey were reviewed. Headlines mentioned people with mental disorders and violent events. The News Headline Review Form was used to evaluate the headlines. Descriptive statistics, the chi-square test and logistic regression analysis were used in data analysis. RESULTS: It was determined that violent events in headlines were mostly associated with homicidal behaviors (72%; n = 439), self-harming behaviors (20.2%; n = 123) and exploitation by others (7.8%; n = 40), respectively. The most common actions in headlines were, within the homicidal behaviors, "murder" (30.4%; n = 186); within the self-harming behaviors, "commit suicide" (13.6%; n = 83) and within the exploitation-by-others category, "being murdered" (4.4%; n = 27). People with mental disorders were in an active position in three fourths of the headlines on violence/aggression (77.3%; n = 471). CONCLUSION: Headlines have the effect of normalizing the relationship between violence and mental disorders, which already exists in society. Portraying violence as a typical part of a mental disorder could create social perceptions that it is the nature of these individuals to exhibit violent behavior.

Evaluation of the Effectiveness of Psychoeducation Given to Children with Parental Psychiatric Disorders.

This study was aimed to determine the effectiveness of psychoeducation program which was developed to improve the coping skills and to increase the psychological resistance of 12-18 years children/adolescents whose parents' have psychiatric disorders. The study was carried out between May 2018 - November 2019 with children of patients who applied to the outpatient clinic and inpatient treatment at Istanbul University - Cerrahpasa, Cerrahpasa Faculty of Medicine Department of Psychiatry. Total of 40 children (experiment = 20 and control = 20), participated in the study. Data were collected using Personal Information Form, Adolescent Psychological Resilience Scale and Kidcope. The mean age of the children/adolescents in the experimental group was 14.05 ± 1.90, 50% was male and the mean age of the control group was 15.35 ± 2.08, and 55% were male. It was determined that the mean duration of psychiatric disorders were 11.50 ± 6.39 years and 40% of the psychiatric diagnosis was schizophrenia in the experimental group, and the mean duration psychiatric disorders were 6.10 ± 5.16 years and 30% of the psychiatric diagnosis was a depression in the control group. After psychoeducation, the total scores of scales in the experimental group showed an increase compared to the control group and a significant difference in a statistical context. It was found that children/adolescents participating in the psychoeducation program had increased psychological resilience levels and improved coping skills. This result shows that the psychoeducation program for children/adolescents with psychiatric disorders in their parents is effective.

Turkish newspaper articles mentioning people with mental illness: A retrospective study.

BACKGROUND: Because a great majority of the public knows about mental disorders primarily through printed or visual media, the attitudes exhibited in mass media might be predictive in stigmatizing individuals with mental disorders. AIM: The aim of this study was to retrospectively assess the articles in Turkish newspapers that mention individuals with mental disorders. METHOD: This study was designed to retrospectively investigate and analyze newspaper content in Turkey; the newspapers' circulation information was collected by examining the websites of the four newspapers with above 1% of the total circulation. The News Evaluation Form was used to evaluate a sampling of articles that met the inclusion criteria of having appeared in the lifestyle and agenda pages of newspapers, and of using neutral or negative labeling keywords about psychiatric patients. RESULTS: Almost all the articles reviewed were negative toward individuals with mental disorders. Three quarters of the reports were forensic, among which two thirds of the individuals with mental disorders were criminalized, and one third were victims of crime. In approximately half of the news reports, most images were related to the news and were not protected. Although not all the articles contain stigmatizing elements directed toward people with mental disorders, two thirds of the subjects' images in the news were found to have stigmatizing elements. CONCLUSION: Media has an impact on attitudes toward people with mental disorders mostly negatively along with individual experiences and peer interactions.

Initial psychometric evaluation of the physical health attitude scale and a survey of mental health nurses.

WHAT IS KNOWN ON THE SUBJECT?: A clear association exists between serious mental illness (SMI) and poor physical health. Individuals with SMI have markedly higher risks for mortality and morbidity. Mental health nurses play an important role in enhancing service users' mental and physical well-being. The attitudes of mental health nurses towards physical health care have been explored in the western part of the world. However, cross-country differences should be determined to reveal the importance of this global issue. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study adds new data to the literature on the Physical Health Attitude Scale's (PHASe) validity and nurses' attitudes when working in acute mental health services in different cultures. Nurses in acute mental health wards mostly focus on the basic physiological indicators of patients' existing physical health problems, so health promotion practices such as sexual health and eye/dental examinations are neglected for individuals with SMI. Nurses' higher level of confidence about their delivery of physical health care is due to their familiarity with basic nursing practices (e.g. monitoring blood pressure and checking blood glucose levels). Differences that exist between countries in relation to smoking habits are probably due to different regulations. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: To improve patients' physical healthcare outcomes, nurses should be provided with additional training and supervision to strengthen their skills and confidence. Nurses' perceived need for additional training reflects the importance of physical health care in mental health settings, in which training could substantially improve patient outcomes. Authors believe that standard protocols must be established in acute psychiatric care to eliminate obstacles to holistic patient care. Training needs of mental health nurses on health promotion practices should be considered by administrators of mental health settings. Abstract Introduction Nurses play an important role in improving the physical health of individuals with serious mental illnesses. The literature on the attitudes of mental health nurses towards physical health care provides a small amount of data. Assessing trends in nurses' attitudes through suitable surveys is important to ensure holistic care. Aim/Question This study sought to examine the Turkish version of the Physical Health Attitude Scale's (PHASe) validity and reliability and to survey Turkish mental health nurses' attitudes towards physical health care. Method The sample consisted of 174 nurses working in acute psychiatric wards. Firstly, the psychometric properties of the scale were analysed using factor analysis and measures of internal consistency and reliability. Then, the survey results of the attitudes of mental health nurses towards the physical health of patients with serious mental illnesses were determined using the Physical Health Attitude Scale (PHASe). Results The translated PHASe functioned best as a 24-item version and 4-factor solution that explains 51.3% of the variance. The internal consistency value was 0.83. The respondents' attitudes were generally positive about their role. There was less agreement for the involvement of nurses in practices of health promotion, such as sexual health, eye and/or dental examinations. The nurses surveyed also tended to use smoking for therapeutic purposes. Implications for practice Mental health nurses' knowledge and attitudes should be enhanced by additional training in the ways of meeting patients' biopsychosocial needs. Obstacles to physical health care can be removed by implementing standard protocols nationwide.

Physical Healthcare of People with Serious Mental Illness: A Cross-Sectional Study of Nurses' Involvement, Views, and Current Practices.

Background: Based on the poor physical health and unhealthy lifestyle behaviors, people with serious mental illness (SMI) have a high risk for long-term disorders such as diabetes, cardiovascular and respiratory diseases. Aims: This study examined nurses' current practices and views regarding the physical health of people with SMI. Methods: Cross-sectional study was conducted among nurses working in acute wards in large mental health hospital in Istanbul, Turkey. Convenience sample of 184 nurses agreed to participate in the study. Data collection was based on the self-reported responses. Descriptive statistics and comparison tests were used to describe the sample's characteristics and identify associations amongst the participants' characteristics. Findings: The results showed that nurses considered the patients' physical health important, particularly female nurses. Monitoring blood pressure, assessing physical health status at admission, and helping self-care needs were common practices. Believing in the importance of physical health was correlated with high knowledge and self-confidence levels in delivery of physical healthcare. Discussion: These findings are useful for implementing integrated nursing care in acute psychiatric care and improving patients' mental and physical well-being.

Risk predictions of physical aggression in acute psychiatric wards: Findings of a prospective study.

This study was conducted using prospective methods to analyze predictions of the risk of physical aggression from patients with a mental illness and the variables used in these predictions. A total of 252 individuals participated in the study, all of whom were inpatients in acute psychiatric wards. Data were collected using a questionnaire consisting of two questions designed to determine the nature of predictions of the risk of physical aggression from mental health patients at admission and the variables used to make these predictions. Descriptive statistics and χ2 -tests were used for the data analysis. For approximately two thirds of the patients (61.9%, n = 156), a low-level risk was predicted. The rate of patients predicted to demonstrate physical aggression was significantly higher. Nurses were better able to predict non-aggressive behavior than risks of aggressive behavior. To improve the accuracy of predicting which patients with a mental illness will show aggressive behavior, a risk assessment should be conducted during hospitalization. Using a person-centered approach, administrators in psychiatric settings should adopt an integrative perspective, considering individual and environmental factors, via a multi-disciplinary approach.

Effects of scalp block with bupivacaine versus levobupivacaine on haemodynamic response to head pinning and comparative efficacies in postoperative analgesia: A randomized controlled trial.

Objective This study was performed to determine the effects of scalp blocks with bupivacaine versus levobupivacaine on the haemodynamic response during craniotomy and the efficacies and analgesic requirements of these drugs postoperatively. Methods This randomized, prospective, placebo-controlled, double-blind study included 90 patients (age, 18-85 years; American Society of Anesthesiologists physical status, I or II). The patients were randomly divided into three groups: those who received 20 mL of 0.5% bupivacaine (Group B, n = 30), 20 mL of 0.5% levobupivacaine (Group L, n = 30), or saline as a placebo (Group C, n = 30). Scalp blocks were performed 5 min before head pinning. The primary outcome was the mean arterial pressure (MAP), and the secondary outcomes were the heart rate (HR), visual analogue scale (VAS) scores, and additional intraoperative and postoperative drug use. Postoperative pain was evaluated using a 10-cm VAS. Results During head pinning and incision, the MAP and HR were significantly higher in Group C. The additional drug requirement for intraoperative hypertension and tachycardia was significantly higher in Group C. There were no significant differences in MAP, HR, or VAS scores between Groups B and L. Conclusion Both bupivacaine and levobupivacaine can be effectively and safely used for scalp blocks to control haemodynamic responses and postoperative pain.

CT-Guided High-Level Percutaneous Cervical Cordotomy for Intractable Cancer Pain.

AIM: To evaluate the safety and effectiveness of computed tomography-guided high-level percutaneous selective cervical cordotomy (CT-guided HPSCC). MATERIAL AND METHODS: CT-guided percutaneous procedures were performed in fifty-nine patients between the years 2004- 2013 for cancer pain. Forty-eight patients with cancer-related body pain were treated with CT-guided HPSCC was evaluated retrospectively. RESULTS: CT-guided HPSCC was performed in 33 male and 15 female patients. The mean age was 49.93 years. The distance between skin-dura, anteroposterior diameter and mediolateral diameter was measured as 40 to 71.1 mm, 8 to 88 mm and 8 to 99 mm respectively. The mean postoperative Karnofsky Performance Score (KPS) was 95. Mean preoperative Visual Analog Scale (VAS) score was 9.6, and 3.6 on postoperative day 1. The 6 < sup > th < /sup > month follow-up VAS score was 6.8. Preoperative total sleeping hours in a 24-hour period were 5.5 hours, which increased in the immediate postoperative period to 8.5 hours. The most common pathology treated was bronchogenic carcinoma. Six of the procedures were bilateral and there were no permanent complication due to the procedure. CONCLUSION: CT-guided HPSCC is still very effective, cheap and repetitive procedure for cancer pain. The procedure should be performed by experienced surgeons and although there is a hegemony of opioids, the number of surgeons that perform the procedure must be increased.

Mobbing Exposure of Anaesthesiology Residents in Turkey.

OBJECTIVE: In recent years, psychological problems that are caused by working conditions, like burn out syndrome, are more commonly observed. In our study, we aimed to evaluate mobbing exposure, factors causing mobbing and precautions for mobbing in residency students who are educated in anaesthesiology and reanimation clinics in Turkey. METHODS: After obtaining consent from the ethics committee, we sent our questionnaires to the secretariats of the departments by postal mail. Completed questionnaires were collected in our department's secretariat blindly and randomly mixed. One hundred and one participants were returned the questionnaires. Data was statistically analysed in SPSS 21.0 software programme. RESULTS: During residency programme, sated to have experienced mobbing one or more time. Interestingly, 5.9% participants complained of physical mobbing. Mobbing exposure was more common in females. The most serious new onset psychosomatic symptoms stated during residency were committing suicide (2%), addiction (16%), severe depression (18%), panic attack (8%), more accidents (7%) and tendency of violence (15%). In mobbing group there was statistically significant dissatisfaction rate. CONCLUSION: In professions where mobbing is common, incidences of psychiatric diseases and suicide attempts are high are increased. Who are under risk for experiencing mobbing should be noticed carefully to ensure good judgement and problems should be inspected objectively in a detailed manner. Anesthesiology societies and other medical professional societies should establish mobbing committees. Thus, mobbing problems can be resolved and healthy career oppurtunities can be presented to residents.