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Who are we? Low self-esteem and marital identity.

Low self-esteem is a common problem with clients seen by psychiatric mental health nurses in both inpatient and community settings. Gordon (1982) describes the nursing diagnosis of self-esteem disturbance as "negative feelings or conception of self," including social self or self capabilities. Defining characteristics include lack of eye contact, head and shoulder flexion, self-negating verbalizations, expressions of shame or guilt, and evaluations of the self as unable to deal with situations or events. Empirical validation of this nursing diagnosis has recently been provided by Norris and Kunes-Connell (1985). Stanwyck (1983) incorporates both affective and cognitive components in his definition of self-esteem as "how I feel about how I see myself." He suggests that factors related to the development of self-esteem include interactions with significant others, social role expectations, psychosocial development crises, and communication/ coping styles. Studies have documented a relationship between low self-esteem and physical and mental illness (Antonucci, 1983; Schafer, 1981). Nursing care of the adult client with low self-esteem has traditionally focused only on the individual. Interventions are typically designed to promote realistic self-appraisal and to change patterns of thought that cause negative feelings and low-esteem (Crouch, 1983). This article describes a family systems nursing approach to assessment and intervention of low self-esteem. A family systems nursing approach purports that individuals are best understood within their relational contexts. The case example demonstrates specific assessment and intervention strategies that can be used when nurses are confronted with this common psychosocial problem.