mother-child interaction among the alaskan eskimos

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Mother-Child Interaction Among the Alaskan Eskimos

Nancy J. MacDonald-Clark, RN, MSN, MPA, June L. Boffman, RN, EdD

This is an exploration of the world of the Yup'ik Eskimos, who live on the Bering seacoast in rural Alaska. The Eskimos have an ancient culture that has survived the harshest of environments. Although geographically isolated, the Eskimos have become increasingly acculturated to the Western culture. The authors studied maternal- child interaction and quality of the home environment in two remote villages and report their experiences, the Yup'ik Eskimo culture, research findings, and implications for nursing practice.

Living in this kind of culture, in this harsh environment, in this part of the world, you have to have an understanding in the sense of sharing and love to survive (Tom Fields, as quoted in Berger, 1985). Bethel, Alaska: It was mid-October, 1990, 9 a.m.,

19" F, dark outside, with a fresh blanket of snow covering the ground. While waiting for a taxicab to the airport, various house guests ate breakfast together and chatted about where they were going and why. The taxi arrived, delivered us and our duffel bags to the porch of the airport, then sped off into the darkness. The airport con- sisted of several rooms, but its size belied its importance. Bethal is the commercial hub for the Yukon-Kuskokwim delta in southwest Alaska. It also is the site of the regional United States Public Health Service (USPHS) hospital that provides for the medical needs of the Alaskan natives: the Eskimo, American Indian, and Aleut.

We soon were joined by the escort itinerant public health nurse at the airport and were introduced to several other nurses. They would be traveling the first leg of the journey into the bush with us before they changed planes and scattered in different directions to various villages. These public health nurses were employed by the Alaska Department of Health and Human Services and worked out of the regional health center in Bethal. Each public health nurse covered a geographic area similar to district

nursing in the Lower 48; however, their responsibility covered hundreds of miles that are accessible exclusively by air, boat, or snow machine, and they could travel only when weather permitted.

This journey had been preceded by a year and a half of planning. The preparations began when the authors learned that Alaskan public health nurses were con- cerned about the appropriateness of using Nursing Child Assessment Screening Tests (NCAST) on their clientele. Because of an alarming increase in child abuse throughout the state, the Alaska Department of Health and Hu- man Services, Division of Public Health Nursing, re- quested all public health nurses to begin using NCAST and Home Observation and Measure of the Environment (HOME) scales in their assessments of families with young children (Department of Health and Social Ser- vices, 1990). These scales are used to help identify situations at risk for problem development at a time when in- terventions can be most effective. They have been suc- cessfully used in public health departments in other states and some foreign countries.

NCAST Scales were developed and standardized by Dr. Kathryn Barnard, of the University of Washington, in the 1970s (Barnard, 1986). They consist of two scales, the Nursing Child Feeding Scale (Feeding Scale) and the Nursing Child' Teaching Scale (Teaching Scale). These scales specifically look at mother (or caregiver)-child interaction. The HOME scale was developed and standardized by Dr. Bette Caldwell, University of Arkansas, in the 1960s (Barnard, 1986). These three scales were standardized on white, black, and Hispanic families (Barnard, 1986). It was the concern about the appropriateness of the use of these tools with the Alaskan native population that led us to two remote villages located at the mouth of the Yukon River, where Yup'ik Eskimos reside. This opportunity allowed us to learn about the Yup'ik Eskimos and to make some interesting observations of mother- child interaction and the quality of the home environment. Because of fiscal and time constraints, we visited only one group of Alaskan natives. The Eskimos were

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chosen because their population was the largest. The Es- kimos number 44,401; American Indians, 31,245; and the Aleutians, 10,052 (US. Department of Commerce, 1991).

The regional public health nurses chose these particular villages because they were considered moderate in acculturation. There are 49 villages in southwest Alaska, some of which are more traditional than the two chosen for the study, whereas others were more modern. In the villages studied, the children still learned to speak Yup’ik as their first language and English as their second.

Gaining access to the villages was facilitated greatly by the nursing director at the health center, and most no- tably, by the itinerant nurse. She had worked in the area for 13 years as a public health nurse and a family nurse practitioner. She was clearly a vital part of the community who made scheduled visits to her assigned villages ap- proximately every 6 weeks to conduct clinics and deliver public health services. Between visits, the health office was staffed by trained health aides, who could handle routine concerns with the assistance of medical backup by telephone from the regional USPHS hospital. Com- plex emergency care could be obtained only by air transport, weather permitting. Because of the nurse’s much-appreciated work and her caring manner, she was not only accepted by the villagers, but also was enthusi- astically sought when word spread of her arrival. It was she who took the time-consuming task of securing permission for us to work with the mothers and young children from the village council. Obtaining permission to work in a village can be a formidable task for outsiders.

The population of the first village was 489; the population of the second was 642. They were both subsistence villages, meaning that the population still hunts, fishes, and gathers to survive. In Alaska, this way of life fulfills not only an economic need but also a spiritual one. It is not the same kind of life one usually thinks of as “subsistence” in other parts of the United States, where the term usually brings to mind impoverished farmers. To the Alaskan natives, their lives and their spirits are tied to the land and are considered to be rich and fulfilling (Berger, 1985). Today, snow machines often are used, rather than dog teams; guns are used, rather than bows and arrows; and aluminum boats have replaced animal-skin kayaks, but subsistence has continued as a way of life.

We were cautioned by an anthropologist to be careful in using the term “Eskimo.” However, we found the villagers preferred to be called Eskimos. “We eat Eskimo food, live in Eskimo villages, sing Eskimo songs and dance Eskimo dances. We are Eskimos,” proclaimed one proud resident. Indeed, in our experience, the sentiment appeared to be universal.

Electricity was installed in both villages only 10 years ago; however, only the second village had indoor plumb- ing. The USPHS recently had constructed a washateria in both villages; villagers could use the washing machines and dryers to clean clothing and also could take a shower or use the sauna at the facility. The washaterias were heavily used. A few telephones were available in the vil-

The Eskimos have a long history of working and playing together in a culture that

depends on sharing for survival.

lages, but two-way radios were the primary method of communication.

In sharp contrast to the primitive living conditions, each village had modern elementary and high schools, complete with computers. Television was available in homes via satellite, and this new-found recreation served to broaden the villagers’ exposure to the outside world. Some natives leave village life when they reach adult- hood for employment elsewhere or, more rarely, for college. However, most remain in the village or a nearby village, where they can reside in a familiar and supportive environment. Many within the village had extended families who worked and played together.

Eskimo culture

The Eskimos have a long history of working and playing together in a culture that depends on sharing for survival. The migration of the Eskimos from Siberia to the Ameri- can continent is thought to have occurred 10,000-13,000 years ago. They are considered to be part of the Siberian Mongoloids and probably were the last migration across the land bridge to the new world. Earlier, migrations set- tled in the interior, but the Eskimos spread out on the coast, the Inuit to the north and the Yup’ik to the south (Fienup-Riordan, 1983).

First contact with whites dates to 1818, when the Rus- sians first came to the area in the interest of the fur trade. Because the region was so difficult to reach, it eventually was left to the Catholic missionaries. After the purchase of Alaska by the United States, Protestants entered the missionary field. Today, one finds influence from the Mo- ravian, Catholic, and Protestant religions (Fienup-Rior- dan, 1983). The villages that we visited were predomi- nantly Roman Catholic.

Because of the harsh and isolated environment, the Eskimo culture developed a high degree of sharing to survive. It is a land of snow and ice from early October to late April or early May, when the frozen rivers and coastal ice begin to melt. The Yup’ik culture historically has been sustained by the land, and whether food was plenti- ful or scarce, it was shared among all in the village (Yupi- katak, 1974). Interestingly, the Yup’ik language had no words for rich or poor, and the concepts were virtually unknown until contact with whites. To the outsider and by federal standards, some Yup’iks may be classified at the poverty level, with their subsistence life. Indeed, during the last 30 years, some villagers have relied on programs such as Aid to Families with Dependent Children (AFDC) and food stamps to help them provide for them-

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selves throughout the winter. Some argue that these government programs are changing subsistence villages because few want to trap during the cold, dark midwinter months when welfare benefits are available (Collier, 1973).

Regardless of how a family survives the winter, after the spring breakup of ice, the villages again become alive with preparations for spring and summer fishing, hunting, and gathering. Some movement to summer fish camps along the Yukon is necessary for these villagers, and these camps are inhabited during the salmon runs, which occur throughout the summer. Salmon have sup- ported the Eskimo family for generations (Rennick, 1988), and entire families migrate to the camps to work together. In addition, nearly 100 million shore and water birds nest in the Delta during the cool, cloudy summers. The fish, birds, sea mammals, and some other small mammals provide abundant food resources and help explain why the Yup’ik Eskimos are the largest Eskimo population on the continent today.

Families dominate the Yup’ik society. Together they work for food, shelter, and clothing. In the past, a signifi- cant aspect of their society was the qasgiq, or community house, which served as a place to eat, sleep, or work for men. Ceremonies and celebrations took place there, and women and children attended such functions but other- wise were not permitted. This was the place where the men, who were the hunters, socialized, ate, and sometimes slept. The mystique of their culture was passed on in the spacious, earth-covered communal house. Travel- ers were given shelter, food, and entertainment in the qasgiq. Sometimes the men would slip away after mid- night and join their wives in their homes (Collier, 1973). The Moravian missionaries did away with the qasgiq, in- sisting that the men live with their wives. Today the sau- nas found in the villages probably fulfill a part of the qasgiq’s previous function. Families now live together, usually in their own rectangular homes, which have been elevated for protection from spring flooding. The homes are simple, consisting of only an open living and kitchen area and perhaps a couple of separate bedrooms. The homes are heated by oil, and we found them to be un- comfortably warm. The igloos or ice houses that most as- sociate with the Eskimos are a part of their nomadic past and usually are built today only if a hunter is caught in an unexpected storm.

The Eskimos love children, and parents were quite permissive with them. Girls were taught to cook, raise children, butcher, and process fish, meat, and furs. The home was not typically a place for discipline or learning male skills but was viewed as a place to play and to love children (Collier, 1973). Indeed, the division of labor was evident throughout the villages at the time of the NCAST research project. It was seal hunting season, and many seals were observed throughout the villages. The men made the catch, and the women did the butchering. If it was snowing outside, the animal was simply hauled inside, and the whole process proceeded on a cardboard-

covered floor. Seal skins were stretched and drying in and out of the homes for future use.

Other important aspects of the Eskimo social life included marriage and children. Marriages traditionally were arranged, although this rarely occurs today. Individ- uals may have a number of trial marriages before settling down with one mate (Fienup-Riordan, 1983). Children have been looked upon as security in subsistence cultures, and a marriage is solidified with the birth of a child (Collier, 1973). Adoption has been and remains a wide- spread practice in this culture. It has served to assist those who have no offspring and those whose children have grown, leavinh no one to help with the labor-intensive household and subsistence activities. Adoption usually has been within the extended family (e.g., grandparents) and the child ‘was aware of who the biological parents were and frequently interacted with them. This practice has been referred to as “being adopted out” or traditional adoption. The child’s parents may or may not be married; however, Eskimos do not consider any child to be illegit- imate, and every child has always been welcomed and loved.

Modern changes were found in the political organization of the villages. The communities had a city admin- istration, including a city manager, mayor, and elected city council members. They also had a local magistrate and federally recognized tribal council. Traditionally, communities were governed by family heads, and each family was responsible for the behavior of its members. Despite representative government, elders continue to hold considerable prestige and are influential in their communities CShinkwim, 1983).

Access to wage employment has been limited in the villages. Paid employment existed mainly through commercial fishing, city (village) or corporation employment, or employment with Head Start or elementary or high schools. A few federal government positions existed, such as post office employment.

The Eskimo world has been changed by the missionaries, World War 11, and the white schoolhouse. Under the Bureau of Indian Affairs, white education was begun in the villages; this educational system usually was preceded by missionary education. During that period in history, children had to leave the village for boarding school to obtain a secondary education. Today, high schools have been sponsored by the State Department of Educa- tion and are located in the villages, and most children graduate from high school.

Once inside the door of a village classroom, a casual observer would not know she was in a remote Alaskan classroom. The classrooms are replete with modern equipment and have qualified (although usually white) teachee. The students are taught just as others are in the United States. ,Past researchers have been critical of the lack of cultural sensitivity in these classrooms, and as a result, teachers are making attempts to modify their teaching to make it more relevant to the culture (Collier, 1973). High school programs often were intended to lead a child to college or a career; however, the village gradu-

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ate often has had difficulty locating employment because wage-paying jobs are scarce. Some graduates migrate to the cities only to find that they are not prepared for life in that society, yet they are not well prepared to live in the bush either (Yupiktak, 1974). It seems during the years that the children should be learning the skills needed to live off the land, they are in a classroom learning state- mandated lessons. Today education for survival is provided by students going out into the field when school schedules permit.

Another difficulty with education was the manner in which teaching was accomplished. The Eskimo style of learning was indirect, or by error correction. Great care was taken not to embarrass or discourage a learner (Col- lier, 1973). Eskimos traditionally learn by observation and are nonverbal, whereas whites learn more by the verbal method.

Interestingly, it was against this backdrop of sharing and love that domestic violence has been increasing and has become a major concern in Alaska. Research has shown a clear association between problem drinking and domestic violence (Shinkwin, 1983). The villages in which this study was conducted were classified as “dry,” but alcohol and substance abuse were evident in the research setting; indeed, both of the villages had a women’s shelter. It was this concern that was the impetus for the Alaska Department of Health and Human Services to ask public health nurses to use the NCAST and HOME tools and ultimately the authors to study the appropriateness of these tools within this population.

In the Yukon-Kuskokwim area, the Eskimos exist precariously in two worlds simultaneously: their traditional world and the Western world. Our entry into their world was facilitated by the itinerant nurse, and our im- pending visit was advertised by a villager on closed-cir- cuit television. When we arrived and walked to the village from the landing strip, one of our first activities was meet- ing the mayor and the city manager, both of whom were natives. The remainder of the day was spent walking about the village to become familiar with the area and enable the villagers to observe us. Many tbld us that acceptance would not be a problem because the villagers knew from past experience that nonnative women who came into the village were there to help and thus were not perceived as a threat. Acceptance also was facilitated by contracting a local, retired health aide. She arranged for interviews and accompanied us on home visits. In the second village, another trusted health aide was con- tracted to assist with our introduction. All of these factors contributed to our acceptance and made the research go smoothly in an unfamiliar culture.

The assessment of mother-child interaction and an examination of the home environment were accomplished in an intensive 2-week period. Sixty-eight Es- kimo families were observed and interviewed. The authors were both NCAST and HOME trained and certified to use the scales. The data were compared with the normative sample from University of Washington (N = 180>,

including 60 caregiver-child dyads from three different ethnic groups (white, black, and Hispanic).

NCAST The population included families selected by the health aides, public health nurse, or volunteers who heard about or met the authors in the villages. We excluded families with the high risk factors of prematurity, abuse, or failure to thrive because previous research had revealed significantly lower NCAST test scores for these subgroups. The families we assessed and the normative sample were similar in marital status and age of the child but differed with regard to parent education. Fifteen percent of the Eski- mos had some college education (none were college graduates) compared with 53% with college education in the normative group, of whom 27% were college graduates. The difference in education was important to re- member as one learned about these families because sig- nificant differences were found associated with education and ethnicity.

NCAST Feeding scale The Feeding Scale is divided into six subscales: sensitivity to cues, response to distress, social-emotional growth fostering, cognitive growth fostering, clarity of cues, and responsiveness to parent. The feeding situation offers a prime opportunity for the trained observer to assess behavior that reflects the parent’s sensitivity to the child, ability to provide growth-fostering situations, and interaction pattern with the child; and the child’s ability to give clear cues and be responsive to the parent. The researchers were able to assess the appropriateness of the use of the tool in this culture and to learn about unique features of interaction patterns in the Eskimo culture. For this article, the focus is on the interaction between the mother and the child. The scores include the six subto- tals, a parent score, a child score, and the total score. The total scores are considered to be the most reliable mea- sures, but the subscale scores often are valuable in assist- ing the nurse to develop appropriate nursing interven- tions.

The Feeding Scale was used to assess 30 families with children younger than 12 months. The assessment was done while the caregiver (usually the mother) fed the child in the home setting. The author assessed the parent-child interaction based on 76 dichotomous items.

The total mean score on the Feeding Scale for the Eskimo sample was not significantly different from that of the normative sample mean. The researchers found interesting differences on three of the parent subscales. The Eskimos scored significantly higher than did the norm in the parent’s sensitivity to cues and the parent’s response to distress. Conversely, they scored significantly lower in the cognitive growth-fostering subscale.

The item analysis of sensitivity to cues revealed the Eskimo parents scored high on all items except the one noting the parent’s response to the child’s satiation. The

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mothers (93% were mothers) tended to be quiet and aware of and responsive to the child’s cues. The mothers gave the impression of being loving, gentle caregivers. Children almost always were in a position where eye contact could be made, and mothers often looked and smiled at their infants. Caregivers were sensitive to even the sub- tle cues given by the child, which indicated a break in the interaction was desired, and tliey modified their response accordingly. This was epitomized by the “walker feeds” that were common to the families visited in which children were old enough to be in a walker. Walkers were used as a substitute for a high chair. The children were free to move about between bites and often were seen moving about the room during the feeding while the mother waited for the child to return for the next serving. The one exception was a feeding provided by a father, who immobilized the walker with his foot to keep the child in place so he could finish the feeding. The feeding was clearly a child-centered event.

Premastication also was observed, but it was less common than it once was because modern kitchen uten- sils have appeared in the villages. In premastication, the mother chewed the food for the child and served it with her fingers when it was soft enough for the child to eat. The synchrony between child and mother was especially evident in that process.

A positive pattern also emerged in the response to distresssubscale. Distress by the infant is a strong cue that something in the interaction needs to be changed and is evidenced by such behaviors as crying, whining, or fuss- ing. The Eskimos did well in this subscale; their scores were significantly better than those of the normative group. Only one-third of the infants actually went into distress. Parents quickly soothed the infant, changed positions, or paused in the feeding. They never made negative comments about the distressed infant, yelled, or used rough handling. The fact that two-thirds of the infants did not go into distress was interpreted as an indication that their needs were being met. The observed behavior was in sharp contrast to the rising statistics of child abuse.

The Eskimos did not score significantly lower in social-emotional growth fostering. The three areas they scored lowest on were engaging in social play, making positive statements, and praising the child on some quality of the child’s behavior. The quiet, unobtrusive nature of the parents tended to preclude a lot of active interaction with the children.

On the cognitive growth fosteringsubscale, the Eski- mos rated significantly lower than did the normative sample. Cognitive stimulation is accomplished by stimulating the child just above the child’s current level of under-

The Eskimo mothers tended to be quiet and aware of and responsive to their

children’s cues.

standing. To do this, the parent needs to assess what the child knows and plan activities to challenge them. The Eskimo’s traditional teaching method has been based on child-initiated learning, rather than parent-structured teaching, and that partially explains the low scores. The Eskimo parent speaks of responding to the child’s interests, rather than planning learning opportunities. An- other possible reason for lower scores was their nonverbal nature. Seven of the nine items in the subscale evaluate verbalization.

The mean scores for the child subscale for clarity of cues and responsiveness to the parent were not significantly different than were those of the normative sample. Exchange with the very young child depended more on sending and receiving ’ nonverbal cues, which Eskimo mother and child did well. The few items that relied on verbal exchange were not scored as well, but they were overshadowed by the clear exchange that occurred with nonverbal interaction.

In summary, the feeding generally was. seen as a meal, not as a time for social interaction or learning. The children had no set feeding schedule but were fed when they were hungry. The parents were attentive to the young children’s needs and were not trying to orchestrate their lives to meet adult schedules.

NCQST Teaching Scale The Teaching Scale is the second of the NCAST tools. The observer focuses on the parent-child interaction during a teaching episode. The parent is asked to teach the child a new task, which is selected by the observer. The task is intended to be just beyond the child’s current developmental stage to ensure a true teaching opportunity for the parent. The teaching episode is shorter than the feeding, but like the feeding, offers a glimpse of the interaction pattern between the parent and child as old as 3 years. The tool has 73 dichotomous items divided into six subscales: parent sensitivity to cues, response to distress, social-emotional growth fostering, and cognitive growth fostering; and the child’s clarity of cues and responsiveness to parent. The teaching observations allowed the researchers to evaluate the usefulness of the tool to assess the Eskimo family and offered opportunities to learn about parent-child interaction with the older child.

The Eskimo total mean scores on the Teaching Scale (N = 63) were not significantly different from those of the normative sample; however, three of the six subscales were different. As in the Feeding Scale, the Eskimos scored significantly higher in the parent subscales of sensitivity to cues and response to distress. Unlike the Feed- ing Scale results, the children scored significantly lower on their responsiveness to theparent.

The subscale sensitivity to cues showed the parents were extremely responsive to signals given by the children, which was consistent with the Eskimo tendency to- ward child-initiated learning. The traditional Eskimo teaching style focuses on responding to the child’s learning interests. Being sensitive to the child’s cues was con-

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sistent with that style of teaching. The nonverbal nature of the Eskimos also was seen here, with the parents offer- ing less verbal-praise; however, this was overcome by the many positive nonverbal signals.

Caregivers again scored well on the subscale response to distress, indicating they were sensitive to their children and successful at soothing them if they gave distress cues. Ninety-three percent of the observed children did not go into distress, and caregivers tended to be sym- pathetic and soothing if they observed distress. None of the parents handled the children abruptly or roughly, yelled at them, or spoke to them in negative terms. Abu- sive behavior does not appear to be an extension of the usual corrective behavior patterns.

The families scored equallywell, in comparison with the normative group, on cognitive growth fostering. The parents did not tend to score well on the verbal items or on following through on the teaching loop, which was consistent with their tendency to let the child set the learning pace. Often the parent simply put the task in front of the child and expected him/her to perform with few instructions and little encouragement. The researchers attributed the positive overall subscale score to the number of items that focused on establishment of a positive learning environment that allowed the child to ac- tively engage in the task. These behaviors were compati- ble with the traditional Eskimo teaching style.

The last significantly different teaching subscale was the child’s responsiveness toparent, the Eskimos scored lower than the normative group. The investigators iden- tified two factors that could explain lower scores in this area. Child-initiated learning focused on the child, rather than the parent, leading the learning episode. Many items measured the child’s attempt to seek cues from the parent or response to cues. If it was not the child’s expectation to be coached by the parent, they would be less likely to seek those cues. The second factor was the novelty of the toys. Because they had few toys, the children were clearly fascinated by the items in the standardized teaching kit. The children were so fascinated that they tended to be unresponsive to their caregivers and all other potential distractions in the environment.

The subscales of social-emotional growth fostering by the parent and clarity of cues by the child were not significantly different from those of the normative sample. The interaction patterns were less verbal, but clear signals were sent and received.

In summary, the two NCAST tools appear to have sig- nificant breadth to allow for cultural differences noted in this Eskimo sample. Nurses working with families from similar backgrounds should recognize the unusual strength of their sensitivity to the child and the gentle nature of discipline. It is important to reinforce these strengths so they are not lost with the continued exposure to Western culture via television and so they can be used as strengths to be built upon to prevent abu- sive situations. With regard to home teaching practices, most caregivers do not use the complete teaching loop of alerting, instructing, allowing performance, and provid-

ing feedback. This is an effective teaching process that could be used in conjunction with the traditional Eskimo approach of child-initiated learning to enhance early child learning experiences and encourage more parent- child verbal exchange.

HOME The HOME is a standardized tool that looks at the quality of the animate and inanimate environment of a child from birth to 3 years. It is divided into six subscales: emotional and verbal responsivity of mother, avoidance of restriction and punishment, organization of the environment, provision of approprlate play materials, maternal involvement with child, and opportunity for variety in stimulation. Scoring is binary and is based on observation of the mother and child and an interview. The highest possible score is 45.

Overall, our research showed that the Alaskan Es- kimo scores on this scale were significantly different from those of the normative sample at the p < 0.05 level. They scored significantly lower on four of the six subscales. We recommend that this scale be used with caution in the Eskimo population until additional research can be com- pleted. However, the results point to some interesting cultural variations that can be best understood by exam- ining each separate subscale.

The first subscale, emotional and verbal responsivity of mother, is designed to look at the emotional atmo- sphere that the mother creates in response to the child’s qualities or behaviors (Barnard, 1986). It consists of 11 items, and the Eskimo results were significantly different from those of the normative sample. As demonstrated by the previously described tools, the Eskimos have a quiet and gentle nature with their children. At times it was difficult to hear speech because they spoke so quietly. In addition, the mother’s use of chewing tobacco, a preva- lent habit, contributed to the difficulty of clear and audi- ble speech. The polite Eskimo mothers did not freely in- terrupt a visitor’s conversation to speak, praise, or teach the child, which the scale would measure as positive behavior. However, the mothers did pick up their infants, place their nose to the child’s cheek, and take a long, na- sal inspiration, which sometimes is referred to a “snig- gle.” This affectionate behavior was observed often. Rarely was any kissing noted.

The avoidance of restriction and punishment subscale was not significantly different. It is a scale of eight items seeking evidence of a consistent environment that has opportunities for exploration without much restric- tiveness or punishment. Neither researcher heard a mother shout at a child, express hostility, or relate an episode of physical punishment, such as spanking or hitting a hand. No scolding or derogating of a child was heard. Children were allowed to roam freely throughout the home, which were compact with combined living and sleeping areas. This subscale also asks if the family has 10 or more books present and visible and if there is a family pet. These two items often were scored no.

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Books were seldom available for the adults or the children. Children learn to read in school, but parents did not report reading to them in the home. Pets are viewed by developmental specialists as stimulating for children. Most of the families had sled dogs, but they were considered working dogs and were not for recreation; in fact, the dogs were tethered to heavy chains in front of their homes. A chorus of barking dogs often filled the village air, and parents did not allow young children near the animals because they were considered to be potential risks.

The third subscale is organization of environment and examines what a typical day is like for the child. Op- timally, a child will have a predictable environment that includes outings, regular health care, safety, and contact with others; the scale also is designed to determine if a child has a special place for toys and treasures. The Eski- mos’ immediate environment appeared safe, and care often was provided consistently by no more than three caregivers when the mother was away. Most children got out of the house to go visiting throughout the village, to go to the general store or to the health clinic to obtain health care. Because the children had few or no toys, a special toy place was not maintained, and the cultural concept of sharing precluded anyone from “owning” toys. The Eskimos scored significantly lower than did the normative sample on this subscale.

Subscale four, provisions of appropriate play materials, contains nine items that assess if the mother provides an optimal inanimate environment with regard to type and quality of toys. The Eskimo’s score was significantly lower than that of the normative sample. Play materials are assessed for sensory qualities, their variety, and whether they help the child gain mastery and promote skill development (Barnard, 1986). As noted, there were few toys in the village. The sharing nature of the Eskimos led to early loss and destruction of the few toys that were present.

Subscale five, maternal involvement with child, contains six items that describe how mothers help their children develop new skills. This scale studies such things as the mother’s conscious encouragement of developmental advance, structuring of play time, and the provision of challenging toys. The Eskimos scored lower on this subscale, and this probably was attributable to the recur- rent issue of lack of toys and to the cultural expectation of child-initiated learning. Parents traditionally have not taught a task until the child showed an interest in it (Har- rison, 1981). This contrasts with Western culture, where the parents often purposefully challenge children with a task that is just beyond their current level of understanding.

The final subscale is opportunities for variety in dailystimulation, and it contains five items that study the frequency of contact with family members and with members of the extended family, caregiving by the father, reading to the child, and the number of books that the child owns. Most did not have three or more books, and the mothers did not read to the children. However,

fathers were eager caregivers when they were not partic- ipating in a fishing or hunting party; the family usually eats together, and the children have frequent contact with relatives in the village. Results of this scale were not significantly different from those of the normative sample.

Eskimo parents traditionally have not taught a task until the child showed an interest, which contrasts with Western

culture, in which parents often challenge children with tasks just beyond their level of

understanding.

How this information should be used remains to be determined. The home environment of the Alaskan Es- kimo remains extremely traditional. Children are respected, loved, and not punished. Material objects are not readily available to the villagers, and the Eskimos do not use them in teaching as do Westerners. However, research has shown that the higher the score on the HOME scale, the better the later cognitive outcome (Barnard, 1986). Many believe that we have an obligation to teach people how to function in their society (Barnard, 1992). If one maintains that the Eskimo lives in two cultures but is becoming increasingly more Westernized, the scale can easily be used by the nurse as a guide for interven- tion. For example, the nurse can teach the importance of reading, toys, the promotion of developmental advance, and giving praise to a child. The HOME scale can serve as a guide, but when it collides with an ancient culture, implementation may be difficult. The nurse must be re- spectful of that culture and recognize that there probably needs to be a balance between the old and the new for now.

S*mma?--

In summary, this project revealed some interesting aspects of mother-child interaction and the quality of the village home environment. Determining the cause of in- creased child abuse in Alaska was beyond the scope of this project; however, it appeared that mother-child interaction with this Alaskan population was positive and not a matter for concern. Children were valued and loved. The mothers appeared to be sensitive to the children’s needs and seemed to be of a quiet, gentle nature. They were not assertive with their children or the visitors. This particular style needs to be respected when working with the Eskimo population, but they may need to be encour- aged to express themselves. In addition, nurses need to be aware that material objects for play are not readily available, and Eskimos do not use them for teaching and

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child development as do Westerners. Nurses could ben- efit from additional study of these issues.

References Barnard, K. (1992, August). Update of the NCAST Scales, in Un-

derstanding Differences: Interuention forpromoting rela- tionships and communication. Conducted at NCAST Insti- tute ’92, Bellevue, Washington.

Barnard, K. E. (1986). Nursing child assessment satellite train- ing: learning resource manual. Seattle: University of Washington.

Berger, T. R. (1985). Village journey. New York: Hill and Wang. Collier, J. Jr. (1973). Alaskan Eskimo education. New York:

Holt, Rinehart and Winston, Inc. Department of Health and Social Services, State of Alaska.

(1990). Public Health Nursing Priorities FY 1990. Juneau, AL: Division of Public Health Nursing.

Fienup-Riordan, A. (1983). The Nelson Island Eskimo social structure and ritual distribution. Anchorage, AL: Alaska Pacific University Press.

Harrison, B. G. (1981). Informal learning among Yup’ik Eski- mos: An ethnographic study of one Alaskan village (Doc- toral dissertion, University of Oregon, 1981). Dissertation Abstracts International, 42,08A.

Rennick, P. (Ed.). (1988). The Kuskokwim. Edmonds, WA: The Alaska Geographic Society.

Shinkwin, A. (1983, August). Homes in disruption: Spouse abuse in Yupik Eskimo society. Fairbanks, AL: University of Alaska.

U.S. Department of Commerce. (1991). 2991 Preliminay area census report. Bureau of the Census. Washington, DC: Su- perintendent of Documents, US Government Printing Ofice.

Yupiktak, B. (1974). Does one way of life have to die so another can live?A report on subsistence and the conservation of the Yupik lifestyle. n.p.

Address for correspondence: Nancy J. MacDonald-Clark, RN, MSN, MPA, California State University, Stantslaus, Department of Nursfng, 801 West Monte Vtsta Avenue, Turlock, CA 95301.

Nancy J. MacDonald-Clark ts a professor in tbe Department of Nursing at California State Untversity, Stantslaus, Turlock, CA.

June I . B o h a n , ts aprofessor in tbe Department ofNursing at California State University, Stantslaus, Turlock, CA.

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