Figure 2. Excerpts from the Domestic Violence Survivor Assessment Form: Issues about the Relationship—Medical Care for Domestic Violence Injuries and Stress

Ignores stress and injuries when with others. Copes alone. Committed to continuing.

For safety, delays care and counseling/therapy. Seeks initial treatment; lies regarding abuse. Considers change: abuse and options

Uses medical care and counseling/therapy. May have ongoing health and emotional problems from domestic violence. Establishes a new life—apart or together.

Source: Jacqueline Dienemann, Visiting Professor, University of North Carolina at Charlotte, Department of Adult Health Nursing, 9201 University City Boulevard, Charlote, NC 28223; E-mail: jadienem@uncc.edu or jpdien@bellsouth.net. Used with permission.

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