Families: Values, Beliefs, Spirituality, Decision-Making
During morning report, the nurse completing the night shift stated that NT’s BP was 199/ 105 and the patient
refused to take the anti-hypertensive medication but he didn’t say why.
You are assigned to this patient – you know that NT is 43 years old, originally from Rwanda and lives in Montreal x 4
months. She was diagnosed with HIV/AIDs in 2008. She was raped and her 2 brothers and in-laws were killed during
the Tutsi and Hutu genocides in 1994.
She is married x 17 years to BU, mother to 2 children ages 11 and 9.
BU immigrated first to Canada in 2008- worked “under the table” and sponsored his family to come to Canada . He
is working as a volunteer at the YMCA and will attend U of M Social Work program in the fall.
NT has strong faith, goes to church every Sunday and is a homemaker while waiting for her work permit.
The family lives on welfare.
Factors Influencing Family Behaviours
Family value system
o “Value is an enduring belief that a specific mode of conduct or outcome…is …preferable to the opposite…”
o Values serve as guides to action and guides to behaviour and are enduring.
o Within the family, values guide the development of family beliefs, norms or rules.
o Values are not static, and hierarchical – some more central to family lifestyle and daily functioning.
o Value – relative worth, merit or importance.
o Examples – cleanliness, freedom, education, privacy, hard work
o “beliefs are the lenses through which we view the world”
o Confidence in the truth or existence of something which is not immediately available for rigorous testing.
o Belief systems organize family functions, tasks and how to approach a crisis situation or normative
o Beliefs have social and cultural roots. Different cultures have strong beliefs about illness, cause and
o Past experiences have effect on beliefs.
o Families generally have strongly held beliefs about spirituality and religion
o Influence on beliefs (Social Learning Theory)
How much an individual believes they can influence or control health through own action – self
Internal locus of control – take initiative for health care, seek information – may be associated with
higher self-esteem, purpose in life, sense of well-being, self-reliance.
External locus of control- health is controlled by outside forces – influence on response to illness,
Sense of coherence – search for understanding of problem, confidence in ability to manage the
problem, stressors viewed as challenges- fosters healthy adaptation to unexpected or chance
events, family feels grounded, family learns may coping and self-regulation strategies.
The notion of controlling an illness is intertwined with the belief about what needs to be healed.
What are person’s beliefs about healing?
Presenting options about how to manage illness is itself one way of increasing individual control.
o Investment in internal values that bring a sense of meaning, inner wholeness & connection with others.
o May involve a set of values towards which one is striving; belief in a supreme power; oneness with nature
and the universe.
o Spirituality and religion are understood as distinct from one another but interconnected. o Therapeutic conversations provide a means to explore spirituality and to ask:
“I’m curious… have you been able to talk about your spiritual or religious beliefs as much as you
o Means of getting things accomplished is a process in a family directed toward gaining the assent and
commitment of family members to carry out a course of action or maintain the status quo (Friedman, 2003)
Negotiation, discussion, commitment to shared values.
Healthy way to make decisions.
A course of action is mutually agreed on by all involved.
Commitment to decision and satisfaction with the decision. Interdependence and egalitarianism is
needed and ability to discuss and problem solve – difficult, complex and unpredictable.
Consensus meets personal or shared values.
Discordant feelings, voluntary assent or sacrifice.
Making of concessions by all family members and has some acceptable elements for all
Concessions to another and expect reciprocity so the sacrifices of both balance out. Trust
exists between family members that others will keep up their end of the bargain.
Least functional – unwilling agreement by family member due to coercive power, idea of
punishment or dominance of one member over another.
o De Facto
Inaction, default – no deliberate action
Decisions made by inaction or default rather than deliberate action.
Seen in disorganized, multi-problem families – believe in fate and feel powerless to control own
May be situation or context driven, or a problem with communication, or due to cultural norms.
Variable Affecting Family Power and Decision-Making Dynamics
Family pecking order – hierarchy downward (ex. parents over children but may be different in single parent families,
Family form – blended family may need to change power hierarchy that previously existed
Family coalition – subgroups in family band together to support each other and to increase their power position
relative to other members of the family (ex. teenage rights)
Family communication networks – two siblings may have a close relationship while third sibling communicates
Gender differences – women generally have less power in family compared to men – economic inequality, cultural
Age and family life cycle – shifts in power from childhood to adolescence
Cultural/ethnic/religious – strongly influence decision making and values and beliefs about illness and treatment
options can be culturally derived
Social class – has its own clustering factors that influence decision-making (Minuchin, 1974)
The most important aspect of power (decision-making) within a family is the presence of clear and functioning
hierarchy in which parents function as the executive subsystem and children have different levels of
authority….there must be complementarity of functions with husband and wife working as a team and accepting
Beliefs About Families A family is a group of