





































Clinical Medicine Insight
Received 10 June 2020 | Revised 15 July 2020 | Accepted 10 Aug 2020 | Published Online 19 Sep 2021

DOI: https://doi.org/10.52845/CMI/2020v1i1a5 
CMI JOURNAL 1 (1), 27−35 (2020) ISSN (O) 2694-4626 

RESEARCH ARTICLE

Perception of Nurses’ Work in Psychiatric Clinic

Dr. Kratika Daniel 1∗
 

 

Dr Vivek Daniel 2
 

1Associate professor, Faculty of
Pharmacy, Mandsaur University,
Mandsaur, M.P. India

2Associate professor, Department
of Pharmacy, JEES, Nandurbar,
Maharashtra, India2Associate

Abstract
Purpose: This study aims to determine the siege and related factors of
nurses working in psychiatric clinics.
Method: This study was conducted as a related description design. The
sample of the study consisted of 204 nurses working in psychiatric
clinics. The data was collected using questionnaires generated by
researchers from literature and workplace psychological abuse scales.
Descriptive statistics (frequency and percentage) and chi-square in-
dependence test are used to determine whether there is a significant
relationship between variables.
Results: The conditions for more frequent siege behaviors are that
nurses have graduate education, work at night, are dissatisfied with
work methods and institutions, have been besieged before, and have an
understanding of the number of legal persons and consulting services
related to Go.
Conclusion: The nursing service management department of the hos-
pital should effectively organize the types of employment and develop
strategies that can improve nurse satisfaction. It is believed that raising
nurses’ awareness of siege will effectively reduce psychological vio-
lence in high-risk wards.
Keywords: Siege, workplace violence, mental health, psychiatry, psy-
chiatric nurse, mental health nurse

Copyright : © 2020 The Authors. Published by Medical Editor and
Educational Research Publishers Ltd. This is an open access article
under the CC BY-NC-ND license
(https://creativecommons.org/licenses/by-nc-nd/4.0/).

1 INTRODUCTION

Mobbing is a nonphysical form of work-
place violence (WBI 2014), a concept
which has different meanings such as de-

terring and pressure, psychological violence, bully-
ing, rudeness, hostile attitude, psychological terror-
ism in workplace (Leymann 1996) and it threatens
employee safety and productivity in the workplace
(Johnston et al. 2009), reduces business performance

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Perception of Nurses' Work in Psychiatric Clinic

(Yıldırım 2009), work and workplace satisfaction
and involves the intention of withdrawal from work
(Wachs 2009, Davenport et al. 2003), causes psy-
chological and physical traumas on person, results
in many negativities for the employee and the orga-
nization. Mobbing is a situation that creates conflict
through showing annoying behavior that targets a
certain person for a long time and systematically (at
least once a week and lasts for at least 6 months).
At the same time, it is a direct or indirect psycho-
logical attack expressed through abusive conduct,
threatening, humiliating, exclusion and intimidation
(Zapf 1999, Davenport et al. 2003, WBI 2014). Ley-
mann, who explained the concept of mobbing for the
first time, defines it as ‘psychological violence or
psychological terrorism towards one person or more
that leaves people helpless and vulnerable through
systematic hostile and unethical communication in
business life’ (Leymann 1996, Karsavuran 2014).
Once mobbing/psychological violence in work-
place is categorized into subtitles; it is actualized
through systematic behaviors to targeted person as
threat/intimidation, blocking communication with
others and isolation from social relations, humilia-
tion/underestimation, direct physical/sexual violence
towards occupational skills. Mobbing has significant
negative effects on work satisfaction, self-esteem
and burnout experience as well as having psycho-
logical, physical and behavioral effects (Bradbury
and Hutchinson 2015, Nielsen and Einarsen 2012,
Iglesias andVallejo 2012, Giorgi et al. 2015). Institu-
tions where there is mobbing, not only the victim but
also the witnesses are affected. These people are both
sorry for the real victim and concerned about being
victimized. Organizations also pay a heavy cost be-
cause of mobbing (Johnston et al. 2009, Iglesias and
Vallejo 2012, Khoshknab et al. 2015, Yıldırım and
Yıldırım 2007, Karsavuran 2014). Mobbing, which
is a state of psychological violence, not only affects

Supplementary information The online version of
this article (10.52845/CMI/2020v1i1a5) contains
supplementary material, which is available to autho-
rized users.

Corresponding Author: Dr. Kratika Daniel
Dr. Kratika Daniel
Email: kratika.daniel@meu.edu.in

employees and institutions in the health sector but
also affects the quality of patient care and patient
safety, leads to medical errors, creates interdisci-
plinary conflict and stress in healthcare professionals
(Hamilton 2007, Johnston 2009). For this reason,
mobbing in the workplace experienced by nurses
who play a critical role in patient care has a particular
importance such as decline in patient care quality.
The main source of mobbing formation is expressed
as personal traits (personal ambition, envy, jealousy,
gender, marital status etc.) (Adams 1992). Heavy
workload and difficult working conditions, unre-
solved conflicts, lack of sense of trust and justice,
ineligible and oppressive executive trigger mobbing
behaviors in situations (Johnston et al. 2009; Park et
al. 2015). Organization climate from organizational
factors is another factor related to mobbing. When
there are negative behaviors in the organizations,
which means the organizational climate is negative,
the employee feels oneself as a mobbing victim and
this causes health problems and burnout experience
for the employees (Giorgi ve ark. 2015). The or-
ganizational culture which tolerates violence in the
workplace is another important factor that creates
mobbing. In the organizations in which the lines
for the mobbing behavior are not drawn, the cli-
mate changes and these behaviors are unintentionally
supported. Nursing is a group of professions where
the female sex dominates, and people who show
mobbing behavior and the victims are female nurses
at high levels. From this point of view, being a fe-
male dominant profession group is closely related to
mobbing. Nurse executives are usually the ones who
show the real mobbing behavior in the profession.
It can be said that personal traits such as personal
insecurity, bad interpersonal communication skills,
low self-esteem and being unqualified for the posi-
tion play a role on abuse of the authority (Johnston
et al. 2009).
As a result of an international study conducted in
2008, including the United States and 17 other coun-
tries, it is stated that according to the employees,
employee safety is not prioritized in the working
environment. Approximately 93% of the responders
are nurses and they stated that mobbing, which is one
of the types of workplace violence, is increasingly
being seen among nurses (Johnston et al. 2009).

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DR. KRATIKA DANIEL AND DR VIVEK DANIEL

Studies on workplace violence show that healthcare
professionals are 16 times more exposed to mobbing
and nurses are 3 times riskier in this group (Kingma
2001). Another study shows that female nurses are
the primary victims of mobbing activities (Iglesias
and Vallejo 2012). In a study conducted in UK, it is
reported that approximately 95% of the nurses’ face
behaviors assessed within the scope of mobbing in
the workplace (Kingma 2001). According to other
international studies; in the study conducted by Fute
et al. (2015), it is stated that 90% of the nurses are
exposed to verbal assault/abuse. Likewise, in other
studies, it is seen that mobbing perception of the
nurses is formed especially with the verbal behaviors
of violence (Efe and Ayaz 2010, Yıldırım 2009,
Ovayolu et al. 2014, Pai and Lee 2011, WBI 2014,
Naime 2012). In the study on workplace violence
which was conducted on 1377 nurses, Hader (2008)
determined that the most frequent types of violence
according to the nurses’ perspective are intimidation,
sudden burst of anger, threatening and disruptive be-
haviors which are categorized under the title of mob-
bing. Yıldırım (2009) determined that nurses face
most frequently personal and occupational bullying.
Quine (1999) identified mostly reported mobbing
behaviors as changing rules unfairly to raise difficul-
ties, hiding necessary information, creating pressure
which blocks production, ignoring, exclusion and
isolating from society with hostile attitude. Efe and
Ayaz (2010), who examine nurses’ state of exposure
to mobbing and its causes, show that while about
10% of the nurses are exposed to mobbing according
to the result of the applied mobbing scale, the results
obtained according to nurses’ own declarations are
33%. Öztürk et al. (2007) reported that 39% of the
nurses were mobbing victims, yet 42% of the vic-
tim groups were found to be real mobbing victims.
When the studies are examined, trying to determine
and measure the mobbing victimization directly by
ignoring the pre-existing negative attitudes of the
individuals related to exposure to mobbing explains
shady height of the results. These differences in
results show us the vagueness as to what kind of
behaviors nurses perceive as mobbing. Each nega-
tive behavior faced in the work environment is not
mobbing. In order to raise awareness for nurses about
this subject, it is an important issue needed to be

practiced with them to determine which behaviors
and processes should be assessed as mobbing.
When factors affectingmobbing in the workplace are
taken into consideration, it is shown that working in
psychiatry units is a factor (Richter 2006, Johnston
et al. 2009, Acar et al. 2014, Sinat 2007). Although
there have been a lot of studies on mobbing, a study
conducted with psychiatric nurses who are under
more risk of stressful working environment that trig-
gers mobbing has not been encountered. That studies
focus generally on rates of mobbing on nurses but it
is not clear which behaviors/situations are perceived
as mobbing by the nurses and that each negative
behavior is perceived as mobbing in the institutions,
this study was planned. Research questions deter-
mined within this scope are;
-What is the mobbing perception of the nurses work-
ing in psychiatry clinics?
-What are the affecting factors of the mobbing per-
ception of the nurses working in psychiatry clinics?

2 METHODS

Type of Research
The research was conducted as descriptive and cor-
relational research to determine the mobbing percep-
tions of nurses working in psychiatry clinics and the
related factors affecting perceptions.
Population and Sample of the Research
Medical faculty hospitals, private mental health hos-
pitals in Istanbul which has the most power to rep-
resent Turkey, ministerial psychiatric hospitals in
Istanbul and 350 nurses working in psychiatry clinics
of training and research hospitals formed the popu-
lation of the research.
The sample of the study consisted of nurses work-
ing in psychiatry clinics (n=296) in 6 hospitals that
allowed the research to be carried out. The sample
size (survey return rate is 69%) was formed with 204
people (Table 1). Nurses who worked in the same
psychiatry clinic at least for 4 months before the
sample selection and accepted to participate in the
study were included in the research.
Data Collection Tools
22 questions including participants’ individual, oc-
cupational traits and states related to mobbing were

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Perception of Nurses' Work in Psychiatric Clinic

asked with ‘Information Form’ developed by the
researcher (Atasoy 2010, Yavuz 2007). Information
form includes 3 sub-sections in total. In terms of
individual traits; questions as to demographic data
such as age, gender, marital status, having children,
in terms of occupational traits; questions about ed-
ucational status, years of experience and working
times, satisfaction, department worked, duty, work-
ing times, number of patients being cared, type of
employment, income status, union membership, in
terms of mobbing states; questions about exposure
to mobbing, institutional features about mobbing,
consultancy and legal compliance are taken place.
‘Workplace Mobbing Scale’, which is used in the
study to determine nurses’ mobbing perception, is
a 28 point scale including mobbing beheviors in
workplace and it is prepared in rating (4 likert type)
question form to determine the mobbing rate and
behavior types (Tınaz 2006). The scale consists of 4
factors and these are work-related behaviors, disrep-
utable behaviors, excluding behaviors, and verbal,
written and visual attacks. Chi-Square was used in
the analysis of data, mean and frequency tests were
utilized. Also, explanatory factor analysis was car-
ried out to classify the articles, which are interrelated
and measure the same dimension, in the question-
naire. Test results were evaluated according to 5%
(p<.05) significance level. Cronbach Alpha reliabil-
ity coefficient of the scale was determined as .93.
Cronbach Alpha values were determined according
to the factors as; .86 for the first dimension, .82 for
the second dimension, .80 for the third dimension
and .79 for the fourth dimension. In order study to be
conducted, required ethics committee approval and
verbal, written consent of the nurses were obtained.
The cronbach alpha valua of scale .92 in this study
that indicates ‘workplace mobbing scale’ is valid and
reliable instrument in Turkish population.

3 RESULTS

Findings belonging to the individual traits of 204
nurses who participated in the research are seen in
table 2.
74% of the participating nurses are women, 40% are
between the ages 31-40, 31% are between the ages

21-30, 58% are married and 54% have child.
When findings related to the occupational features
of the nurses are examined, 58% of them are sat-
isfied with the institution they work with and 54%
are satisfied with the type of employment. 34% are
undergraduates and 35% are associate degree grad-
uates. 86% are service nurses and 43% are working
day/night shifts.
When traits of the nurses in terms of mobbing are
examined, it is seen that 53% of them were exposed
to mobbing during their professional life, 80% of
them had no information about the legal dimension
of mobbing and its counseling and 59% of them did
not receive in-service training related to mobbing.
The responses of the nurses to the articles of ‘Work-
place Mobbing Scale’ are shown in table 3.
As it is seen in table 3, while behaviors evaluated
within ‘work-related behaviors’ sub-dimension of
the Workplace Mobbing Scale are the most fre-
quently encountered mobbing behaviors, behaviors
belonging to sub-dimension of ‘verbal, written and
visual mistreatments’ and ‘excluding behaviors’ are
least encountered mobbing behaviors.
A significant difference was determined between
satisfaction from the institution, education status,
type of employment and satisfaction status, period
of occupational experience, exposure to mobbing
and knowing the processes of consultancy in case
of mobbing from independent variables and sub-
dimensions of Workplace Mobbing Scale. It was
determined that nurses who are partially satisfied
with the institution and type of employment and
who are not satisfied with their work and constantly
work at night, nurses with high level of education
and professional experience between 16-20 years
encounter more mobbing behaviors. It was seen that
nurses who stated that they had faced with mobbing
are mostly exposed to work-related behaviors from
sub-dimensions ofWorkplaceMobbing Scale. It was
found that people who know from which institution
or whom they can receive consultancy or the legal
dimension of the situation in case of mobbing are
exposed to more excluding behaviors.

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4 DISCUSSION

Although there are many studies in the literature
that measure the frequency of nurses’ exposure to
mobbing, it is not clear with how much frequency
a behavior is mobbing, and what the mobbing per-
ceptions of the people are. The majority of negative
situations in workplaces are attributed to mobbing,
which is the starting point of this study. Psychiatry
clinics are units that are more stressed in terms of
working conditions and that working conditions are
heavier due to nurse inadequacy. The aim of this
study, which is based on the hypothesis that psychi-
atric nurses are at more risk for the factors leading
to the formation of mobbing, is to determine the be-
haviors and related factors ofmobbing perceptions of
nurses in general, specifically of psychiatric nurses.
In this context, most of the nurses who participated in
the research are women, married and have children.
When the age ranges are examined, the group with
the highest frequency is 31-40 years old. 97% of
the sample is consisted of nurses working in public
institutions and nurses under the age of 40 represent
71% of the sample. It was determined in this study
that nurses did not differ according to individual
features of their mobbing perceptions. As the female
gender is more common, most of them are married
and have children, it can be considered that the study
reflect the profile of public hospitals employees. In
this study, there is not any difference between the in-
dividual features of nurses in terms of gender, marital
status, having children, age and behaviors perceived
as mobbing. Similarly, Köksal (2011) could not find
a significant relationship between age and exposure
to mobbing. In the study of Yavuz (2007) themed
as ‘factors affecting mobbing perceptions in employ-
ees’, it was seen that as the age increases, the mob-
bing perception increases. Efe and Ayaz (2010) de-
termined that nurses under the age of 25 and Akyil et
al. (2012) determined that young nurses are exposed
to more mobbing behaviors. In their studies, Geçici
and Sağkal (2011) found that female nurses are more
likely to encounter mobbing behaviors. Tınaz (2006)
and Tanoğlu (2006) interpreted this situation as mob-
bing behaviors are encountered more frequently in
the health sector where women work more inten-
sively and women prefer to show passive aggressive

behavior towards their same-gender. Yavuz (2007)
found that employees’ mobbing perceptions did not
differ according to gender. While psychiatry clinics
are an area where male nurses are employed more,
female gender has a 74% rate in this study. In order
to explain the relation between gender and behaviors
perceived as mobbing, studies in which male nurse
sample is more, similar to age independent variable,
are needed.
When findings related to occupational features of
nurses are examined, as the level of education gets
higher, the level of exposure to mobbing behaviors
evaluated within the sub-dimension of work-related
behaviors is at higher level. Significant conclusion
was drawn in terms of behaviors that are disreputable
for nurses with postgraduate education level. In the
study of Yavuz (2007), it was found out that the
employees’ mobbing perceptions increase with the
increase of education level. In their studies, Köksal
(2011), Bardakçı and Günüşen (2016) encountered
parallel findings with this study. This situation can
be evaluated as indicating the competition within
the institutions and it can be considered that com-
petition comes off as a reaction against mobbing
and employees’ promotion. Contrary to mentioned
studies, Akyil et al. (2012) and Efe and Ayaz (2010)
determined that younger and inexperienced nurses
with lower education levels are exposed to more
mobbing behaviors. They associated this situation
to the fact that education in vocational schools is
not sufficient for communication skills and mob-
bing/conflict management. Nurses, who are dissat-
isfied with their work are more likely to encounter
mobbing behaviors. In other words, as satisfaction
decreased, nurses were found to be more likely
to encounter four different dimensions of mobbing
behaviors. When nurses’ type of employment are
examined, those who are ‘always on night’ shift and
are not satisfied with their work reported thay they
are exposed to significantly more mobbing behav-
iors than all other employees. Similarly, Akyil et
al. (2012) and Lin and Liu (2005) reported that the
level of mobbing perceptions of nurses working at
night were higher. In the study of Dilman (2007)
it was stated that the nurses’ level of satisfaction
from the institution they work in and type of em-
ployment is high and that there is not any significant

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Perception of Nurses' Work in Psychiatric Clinic

relation between type of employment and exposure
to mobbing behavior. This situation was explained
as administration of nursing services is effective and
it cares about personnel satisfaction. According to
our country’s standards, large number of nurses are
involved in team work in hospitals during the day
shift, fewer staff are employed in night shifts, and as
a matter of fact only single personnel is employed in
most units. Chronic nurse inadequacy increases the
level of stress of the employees and reduces the level
of interpersonal interaction. This situation facilitates
the emergence of conflicts. The relationship between
inappropriate working conditions and the occurrence
of mobbing behaviors was explained by Tong et al.
(2017). Various factors such as the level and type
of communication, being not able to carry work-
load, sleeplessness and fatigue, biological unbalance
can cause nurses working ‘always on night shift’
encounter more disreputable behaviors and verbal,
written and visual mistreatments. The results of the
research show that there is a significant difference
between the level of satisfaction from the institu-
tion and type of employment and mobbing behavior
(Tong et al. 2017). Employees are more likely to
face mobbing behaviors as their level of satisfaction
decreases. More detailed studies to be done about
this subject should be used to assess the working
conditions of the nurses. Nurses with 16-20 years of
professional experience are more exposed to disrep-
utable and excluding behaviors. Fışkın (2011) found
that the rate of mobbing encountered by the peo-
ple who have 5-9 years of professional experience
is 80%. According to the research result of Bahçe
(2007); mobbing behaviors are mostly encountered
by employees between 11 and 15 years of profes-
sional experience. Akyil et al. (2012) reported that
nurses with less professional experience have higher
rates of mobbing. When looking at the results of
different studies, the relationship between mobbing
behaviors and years of professional experience has
different results. It is thought that more research in
this field with homogeneous and large sample groups
are needed to be done.
In the research, nurses (n:109, 53%), who stated that
they are exposed to mobbing throughout their career,
encounter more work-related behaviors. Most of the
nurses who stated that they are exposed to mobbing

behaviors reported that they did not encounter sub-
dimension behaviors as disreputable, excluding, ver-
bal, written and visual mistreatments. In the study of
Dilman (2007), it was seen that 70% of the nurses
are exposed to mobbing behavior, in the study of
Fışkın (2011), the result was 65% and in the study
of Bardakçı and Günüşen (2016), it was 29%. In
terms of mobbing experience rate, research results
differ from one study to another. Studies show that
nurses encounter high level of mobbing behaviors
and although the subject is not new, it is still a
serious problem in their profession. On the other
hand, when literature knowledge is taken into consid-
eration, systematical exposure to behaviors is needed
in order for people to be regarded as mobbing vic-
tims. Employees should be informed that exposure
to any of the behaviors assessed under the mobbing
behavior should not be considered asmobbing. It was
found that people who know from which institution
or whom they can receive consultancy or the legal
dimension of the situation in case of mobbing are
exposed to more excluding behaviors. In the study
of Arısoy (2011) , it was stated that the situation
of 70% of the nurses not knowing what their legal
rights and obligations are affects their exposure to
mobbing. Aksakal et al. (2015) noted that nurses with
mobbing experience are less likely to adopt concrete
actions such as receive counseling, resort to the juris-
diction, or ask help from professional associations.
Akyil et al. (2012) found that nurses’ awareness of
mobbing is increasing, that they will be able to make
oral and written complaints in response to future
mobbing behaviors and will take an active role in
following this process. On the other hand Aksakal
et al. (2015), Bardakçı and Günüşen (2016) indicate
that nurses prefer to remain unresponsive in case of
mobbing actions and they share their experiences
with family and close friends only. An employeewho
is aware of what his/her legal rights and obligations
are, may be able to identify the mobbing behavior,
have the ability to produce an appropriate solution
to the situation, and differ from other employees by
expressing the situation. This may cause the person
to appear as standing out against senior management
and administration, that is why his/her colleagues
may be uncomfortable to be with him/her and avoid
being called together.

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DR. KRATIKA DANIEL AND DR VIVEK DANIEL

Nurses who reported that they had encountered mob-
bing behaviors at least once in their professional life
stated that the behaviors mostly encountered by them
are ‘every work done by me is observed in details,
works below my professional skills or damage my
self-esteem are required from me, irrational duties
and aims which are impossible to complete are set,
I am not recognized in work-related subjects or I am
interrupted when I speak, my decisions related to
work are questioned and people show negative ges-
tures or glances towards me’. When mostly encoun-
tered mobbing behaviors by the nurses are evaluated
within the typology of Leymann, they belong to the
groups of ‘showing yourself and blocking communi-
cation’ and ‘aggression towards person’s quality of
life and professional status’. In the study of Dilman
(2007), behavior patterns with highest score are de-
termined as ‘always being interrupted, behaving as
if I did not exist in the environment, being ignored,
indirectly control of me and the works done by me’.
The most common behaviors in Dilman (2007)’s
study are within the work-related behaviors from
sub-dimensions of Workplace Mobbing Scale. Üye
(2009) stated that mobbing behaviors, which nurses
are exposed to with the highest rate, are within ‘dis-
reputable and excluding behaviors’ sub-dimension
of Workplace Mobbing Scale. Fışkın (2011) deter-
mined that 65% of the nurses encountered similar
sub-dimension behaviors with this study in the scope
of mobbing behaviors. Sa and Fleming (2016) deter-
mined the most common mobbing behaviors for the
nurses as ‘being charged with works that are impos-
sible to finish, restricting the area of responsibility
and request of works below professional skills’. As
it is seen, nurses mostly encounter behaviors within
the sub-dimension of work-related and disreputable
behaviors.

5 CONCLUSIONS

Independent variables can be predicted more clearly
by wider sampled studies with nurses working in
psychiatry hospitals at private sector and other cities.
As the satisfaction from the institution and the type
of employment decreases within the scope of the
occupational features of the nurses, the percentage

of the nurses encountering all the sub-dimension
behaviors of themobbing increases. Nursing services
administrations in hospitals should effectively orga-
nize the type of employment and specify strategies
that will increase nurses’ level of satisfaction from
the institutions. Nurses with postgraduate education
are more likely to encounter disreputable behav-
iors. A significant relation was detected between all
sub-dimensions of Workplace Mobbing Scale and
exposure to mobbing during career. It was found
that people who know from which institution or
whom they can receive consultancy or the legal
dimension of the situation in case of mobbing are
exposed to more excluding behaviors. Nurses should
be informed about the mobbing with in-service train-
ing programs related to mobbing planned at regular
intervals in institutions, updated information about
the legal dimension related to mobbing should be
given to nurses, and information about the centers
where counseling can be received should be given.
According to the nurses’ responses to Workplace
Mobbing Scale, the mostly encountered behaviors
within work-related and excluding behaviors are;
‘every work done by me is observed in details,
works below my professional skills or damage my
self-esteem are required from me, irrational duties
and aims which are impossible to complete are set,
I am not recognized in work-related subjects or I am
interrupted when I speak, my decisions related to
work are questioned and I am the one who is always
seen as the responsible of every problem’. The results
of the study on mobbing should be shared with the
nursing services administration and nurses in order
to expand awareness.
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CMI JOURNAL 1 (1), 27−35 (2020) MEERP LTD 34



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DR. KRATIKA DANIEL AND DR VIVEK DANIEL

[Mobbing in Healthcare: An Application to Hospital
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How to cite this article: D.K.D., D.V.D. Percep-
tion of Nurses’ Work in Psychiatric Clinic. Clini-
cal Medicine Insight. 2020;27−35. https://doi.org/
10.52845/CMI/2020v1i1a5

MEERP LTD CMI JOURNAL 1 (1), 27−35 (2020) 35


	Introduction
	Methods
	Results
	Discussion
	Conclusions



