Evidence Based Practice for Pain Assessment

Evidence Based Practice for Pain Assessment   Introduction: Pain is a sensation of discomfort that is subjective to each individual, and it is characterized by an unpleasant feeling that can be either physiological or psychological. Acute pain is a sudden feeling of pain, occurring for a short duration lasting less than 3 months and disappearing once the injury has healed. Nurses are the most health care providers present on the unit with patients; therefore, they are the main providers responsible to carry out pain assessment appropriately. Nurses are expected to intervene accordingly to a person’s self-reported pain, and work with the person to manage the pain appropriately. Hence, nurses are required to possess the competencies to assess and manage pain, including knowledge and skills in interviewing techniques, and the ability to do physical assessment and manage pain of individuals who don’t have the ability to self –report (Herr, Coyne, McCaffery, Manworren, Merkel, 2011, as cited in RNAO, 2013). It is evident that unrelieved or poorly managed pain is a burden on the person, the health care system and society (Lynch, 2011, as cited in RNAO, 2013). In fact, 50 to 75 % of postoperative patients do not attain sufficient pain relief (Huang et al., 2001; Chung Lui, 2003, as cited in Bell Duffy, 2009) and some providers underestimate the intensity of the pain for 50% of the cases (Helfand Freeman, 2009). Therefore, this observed nursing practice gives rise to a PICO clinical question. In adult patients with acute pain, does utilizing a standard pain assessment protocol, in comparison to the current practice, affect the pain relief process? Literature review: Effective pain management is a person’s right. Hence, assessing pain, implementing interventions to alleviate it, and prevent it are priorities while caring for a person (Jarzyna et al., 2011, as cited in RNAO, 2013). The article written by Bell and Duffy (2009) inspects two important barriers that serve as obstacles for appropriate pain assessment, which are the beliefs and attitudes of patients and nurses, and time management. Research done by Sloman et al. reinforced that pain can be perceived differently in various cultures (as cited in Bell Duffy, 2009). Regarding the nurses’ attitudes, a triangulated study performed by Schafheutle et al. found that 39.3 % of respondents stated that not having enough of time, enough staff on the units and being overwhelmed with work were major features contributing to unproductive pain assessment (as cited in Bell Duffy, 2009). Regarding time management, an observational study was performed for random nurses that showed that inte rruptions, such as answering the telephones, participating in the multidisciplinary rounds, assisting other nurses and looking for things contributed in poor pain assessment practice. In addition, it was noted that nurses’ priorities were to get all tasks and activities done before the end of their shift rather than allowing time to interact directly with patients to assess their comfort and pain level (Manias et al., 2002, 2005, as cited in Bell Duffy, 2009). While assessing acute pain in adults patients, nurses have to be aware of the routine pain assessment, the choice of measure and the protocols. According to Helfand and Freeman (2009) study, there has been an agreement among most of the institutions that routine assessment of self-reported pain is the best measurement for pain assessment, since some providers underestimate the intensity of the pain for 50% of the cases. According to Helfand and Freeman (2009) study, no evidence was found that directly linked the timing, frequency, or method of pain assessment with outcomes or safety in medical inpatients. It was also noted that instituting routine pain assessment along with an educational component improved rates of assessment and treatment. The protocols in the institutions tend to guide the assessment and the management of pain; hence the assessment should be unified and accurate in order to intervene accordingly. Pain is universal but it is a subjective experience. Hence, it is challenging to obtain adequate objective information about it. Many assessment tools are used to rate and assess pain, such as the Visual Analogue Scale, the Verbal Numeric Rating Scale, Verbal Description Scales, Facial Pain Scales, Brief Pain Inventory and McGill Pain Questionnaire (Helfand Freeman, 2009). For the choice of measure, it must be simple to use by the health care providers, and easy for the patients to understand and able to respond to it (Helfand Freeman, 2009). The Visual Analogue Scale for pain assessment is used universally, however its efficacy and reliability is put to question since it may bias the results. A randomized control trial was tested over forty healthy volunteers where they were induced by thermal laser stimulations. Pain was tested during different sessions using two different visual scales; the classical pain visual analog scale (unbearable pain/ no pain), and the pleasantness visua l analog scale (very pleasant/ very unpleasant). And at same time, somatosensory evoked potentials were measured. Results showed that the thermal laser stimulations that were of low intensity were reported as painful on the visual analog scale of pain, whereas they were rated as pleasant on the visual analog scale of pleasantness. Meanwhile, following the low intensity thermal stimulation, the cerebral responses indicated the activation of only C-fibers which indicate the warm sensations that are not painful. Therefore the somatosensory evoked potential results matched with the pleasantness visual analog scale and not with the classical pain visual analog scale. This signifies that when healthy individuals rate the â€Å"no pain† using the classical visual analog scale of pain, they are more likely to rate the intensity of the stimulation and not their pain perception (Kemp, Despres, Dufour, 2012) EBP Process: Observations In hospital X, Y, Z pain assessment was observed being performed by RNs. However, in hospital X, RNs were not using a pain assessment tool to assess the pain, some were just asking if the patient was in pain or not, even though the Visual Analogue Scale was available on the floor, others for sedated patients, were squeezing the patient’s skin to check response to pain, in addition to assessment of facial expressions and vital signs (heart rate), meanwhile in hospitals Y and Z, RNs were mostly using the Numeric Rating Scale to assess for pain by asking the patient to rate the pain between 0-10, where 0 was explained to be the absence of pain and 10 to be the worst pain. In hospital X, some RNs were observed documenting the pain assessment by filling a pain flow sheet, while others were only seen to document pain assessment on the pain flow sheet if the patient was on Patient-Controlled Analgesia, meanwhile in hospital Y, RNs were observed to document pain assessment per shift b asis, whereas in hospital Z, RNs documented pain assessment only after a pharmacological intervention. In hospitals X and Y, RNs were not reassessing pain after pharmacological interventions, while in hospital Z, RNs were observed to do so. In the three hospitals, RNs were observed to inform the physician if the patient was assessed to have pain. Hospital Protocols: Pain assessment protocols were taken from 3 hospitals: X, Y Z. It is important to note that the 3 hospitals were similar in the method/system that they adopted: The American system. That is, one of the references from which the pain assessment protocol of hospital X was taken, was JCR, J.Caho, Joint Commission Resources (USA), 2003. The protocol was issued on 15/01/2011 and updated on 15/01/2013. On the other hand, hospital Y has the followings as main references: Joint Commission International standards, Hospital standards, 4th edition, January 2011, Care of patient, and 2006 Lippincott Williams Wilkins, Inc., Volume 1 (4), August 2006, p. 20-28. The pain assessment protocol is issued on January 2011 and revised on March 2012. While the pain assessment protocol of hospital Z is based on the Joint Commission International Accreditation Standards for Hospitals-5th edition, JCAHO Pain Management Standards (CAMH 2002) and The Ministry of Public Health (MOH), (2003). The protocol was i ssued on December 2006 and revised on June 2014. We can note that some references are outdated thus the protocols should be often revised to keep them equivalent with the latest evidence based practice. 3 of the pain assessment protocols stress on that pain assessment should be individualized according to the patient’s age and beliefs, values and cultural considerations. Hospital Z adds that pain assessment should be part of patient handover report. Three of the protocols state that assessment of pain should be done: Post-procedure (or within 1 hour of admission), post pharmacological and non-pharmacological interventions, with routine vital signs assessment, at time of discharge, before any planned activities (physiotherapy, stress test, post-operative ambulation). Apart from the assessment of pain, reassessment is considered as a crucial aspect, to monitor the pain level, in the 3 hospital protocols. Hospital Y mentions that prior to reassessment nurses should always refer to the literature of the analgesic agent for its peak action period. In hospital Z when pain is identified (score 2 and above), DMS-MRM-Nursing Sheets-Scale is activated while in hospital Y when pain is i dentified (score three and above), pain assessment and interventions flow sheet is activated. The scales used to assess the pain of adult patients with acute pain common in 3 hospitals is the numeric scale, where the patient is instructed to choose a number from 1 to 10 that best describes his current pain, where 0 refers to no pain while 10 refers to the worst possible pain. Another common pain assessment scale among the three hospitals is the Visual Analogue Scale, where the patient points out his/her pain level across a continuum with the extremities of no pain and worst pain. The FLACC (Face, Legs, Activity, Cry, Consolability) scale is used for critically ill, sedated and paralyzed, intubated and ventilated patients in ICU in hospital Y while it is used for children up to 3 years old in hospitals X and Z. In addition, Adult Nonverbal Scale is used for patients unable to report pain in hospital Z. Similar to the FLACC and Adult Nonverbal scales used in the 2 hospitals, hospital X uses the Behavioral rating scale (components: Face, Restlessness, Muscle tone, Vocalization, Consolability) for patients unable to self-report pain. Wong Baker Facial Grimace is a common scale in the 3 hospitals for patients who cannot communicate their pain, recommended for patients of 3 years of age and older in hospital X, while up to 7 years of age in hospital Y. Guidelines: According to the guidelines mentioned in Assessment and Management of Pain Clinical Practice Guidelines (Registered Nurses’ Association of Ontario, 2013), nurses should screen for the presence, or risk of, any type of pain upon admission, after a change in medical status and prior to, during and after a procedure. Nurses should also perform a comprehensive pain assessment using a systematic approach and appropriate, validated tools and using appropriate tools for persons unable to self-report. The nurses should take into consideration the person’s beliefs, knowledge and level of understanding about pain and pain management. Then, document the person’s pain characteristics. After implementing pain relieving measures, the guidelines state that re-evaluation is important and should be done by reassessment of the pain characteristics, and accordingly documenting the outcomes. There are some validated assessment tools, recommended to be used by the guidelines, and are the following: Faces Pain Scale Revised, Numeric Rating Score, Verbal Rating Score, Brief Inventory Short Form, and Behavioral Pain Scale (See Appendices). Proposed Change/Recommendations: Most of the nurses in the three hospitals were observed to be unfamiliar with the pain assessment protocol. Hence, it is recommended to implement frequent sessions for all nurses to inform them about the criteria of the protocol, identify any gaps, and train them accordingly. Additionally, supervision is essential on each floor to evaluate the effectiveness of these sessions. It is recommended by the guidelines that health-care professionals should participate in ongoing education opportunities to improve their knowledge and skills to be able to knowledgeably assess and manage pain (RNAO, 2013). Apart from hospital setting, the guidelines recommend that educational institutions include guidelines, assessment and management of pain into their curricula for registered nurses, and all health care providers programs to indorse evidence-based practice (RNAO, 2013). It was noted that some of the hospitals’ pain assessment policies were established on outdated references. It is hence recommended that hospitals always update their policies and base them on up-to-date EBP guidelines. In addition, it is also recommended for hospitals to establish a model of care to support inter-professional collaboration for the active assessment of pain and declare pain assessment as a strategic clinical priority (RNAO, 2013). Another common observation was that the three hospitals still used the Visual Analogue Scale, which is not among the list of recommended validated pain assessment tools mentioned in the guidelines (RNAO, 2013) and research found it to be unreliable, since patients are more likely to rate the intensity of the stimulation and not their pain perception (Kemp, Despres, Dufour, 2012). The University of Zurich and ETH Zurich in Switzerland, invented a new method for accurate pain assessment: The Pain Mouse. It is an electronic pain assessment tool that offers credible evaluation, lessening missing data and unclear markings concerning pain. The device captures the clenching reaction to pain through a pressure sensor that is connected to a portable computer (Schaffner et al., 2012). PM is recommended to be used in the near future considering that it distinguishes different levels of pain, is less time consuming, more accurate and can be used for patients with limited physical activity and vision impairment compared to the Visual Analogue Scale (VAS) (Schaffner et al., 2012). References: Bell, L., Duffy, A. (2009). Pain assessment and management in surgical nursing: a literature review. British Journal of Nursing, 18(3), 153-156. Retrieved April 4, 2015, from http://web.a.ebscohost.com.ezproxy.lau.edu.lb:2048/ehost/pdfviewer/pdfviewer?vid=6sid=ff36c8fd-ed44-444c-8182-9487d39e913b%40sessionmgr4005hid=4104 Helfand, M., Freeman, M. (2009). Assessment and management of acute pain in adult medical ‎inpatients: a systematic review. Pain Medicine, 10(7), 1183-1199. Retrieved April 10, 2015, http://web.ebscohost.com/ehost/detail/detail?vid=3sid=7b1adb63-ced7-4486-94ef-4ecc54ddc64b%40sessionmgr111hid=123bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzhAN=2010437732 Kemp, J., Despres, O., Dufour, A. (2012). Unreliability of the Visual Analog Scale in experimental pain assessment: a sensitivity and evoked potentials study. Pain Physician, 15(5), 693-699. Retrieved on April 10, 2015 from http://www.painphysicianjournal.com/2012/september/2012;15;E693-E699.pdf Registered Nurses’ Association of Ontario (RNAO). (2013). Assessment and management of pain (3rd Edition). Toronto, ON: Registered Nurses’ Association of Ontario (RNAO). Retrieved April 4, 2015, from http://rnao.ca/sites/rnao-ca/files/AssessAndManagementOfPain_15_WEB-_FINAL_DEC_2.pdf Schaffner, N., Folkers, G., Kappeli, S., Musholt, M., Hofbauer, G.F.L., Candia, V. (2012). A new tool for real-time pain assessment in experimental and clinical environments. PLoS ONE, 7(11), art. no. e51014. Retrieved on April 10, 2015 from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0051014

The Extent of Fidel Castro’s Achievement of His Aims

To what extent was Fidel Castro able to achieve his aims between 1959 and 1979, and what prevented him from achieving more? During Fulgencio Batista’s reign in Cuba, Fidel Castro had insistently professed his dissatisfaction with the government, and when he finally took over in 1959, he effected a government that formed the basis from which the criticism of many historians today derives. To a minimal extent, Fidel Castro was able to achieve his aims between 1959 and 1979. Revealed in the 26th of July Movement’s doctrine, Castro’s goals called for Cuba to become fully independent and purely democratic while having a just society.Castro’s goals were hindered not only by the dependence on the U. S. , but also on the Soviet Union after relations with the U. S. intensified. By the end of his reign, Castro had not upheld his initial revolutionary ideology; therefore, he did not achieve his aims for Cuba to the greater extent. In one of his aims, Castro hoped to see Cuba become independent. In order to become less dependent on foreign countries, Castro implemented an economic reform that would allow Cuba to become less dependent on the foreign countries. He wanted to create a more centralized economy by confiscating businesses, many of which were American-owned.The U. S. saw this attempt of nationalization as a direct challenge to their interests, thus they removed the sugar quota placed an embargo on Cuba, threatening to destroy the base of the Cuban economy. Cuba had now become independent from U. S. trade, but with no means self-sufficiency, Cuba turned to another group–the socialist/communist nations in the eastern hemisphere. Cuba had increased their sugar production tremendously because of Castro’s speech, â€Å"The Year of Decisive Endeavor,† in 1963 which set a production goal of 10 million tons of sugar by 1970 so that Cuba could industrialize and become more self-reliant.USSR began buying this Cuban sugar in r eturn for industrial equipment and machinery which allowed Castro to develop their countries as allies. Germany also agreed to sell the industrial necessities needed by Cuba. During these early 1960 years, Cuba quickly lost nearly all economic dependence on the U. S. , but any progress toward self-sufficiency was undermined by the developing relationship with the Soviet Union. Unlike the U. S. , the Soviet Union was not hostile to the idea of an independent Cuba and was willing to defend Cuban interest.In reality, Castro might have professed his devotion to socialism in his Marxist-Leninist speech only for the benefit of siding with the world’s socialist superpowers for military and economic support. Castro’s favoring paid off because the Soviet Union placed nuclear missiles in Cuba in 1962; however, this caused U. S. -Soviet tensions to peak when the U. S. made the threat of invading Cuba. Castro also attempted to establish Cuba’s independence by making the cha nge to a Communist state, which began distinguished officially in 1965.Although the changes were small in the early 1960s, it was not until 1976 that Cuba created a new constitution. Another aspect proving Cuban independence was the buildup of a strong military force from foreign intervention and internal opposition. Castro suspected the U. S. of military action because of their discontent with his socialist policies. Nearing the end of the first decade of his reign, Castro revealed that Cuba did not meet the 10 million ton harvest, but welcomed the shame and criticism that the failure would bring about.Throughout the years of Castro’s reign, he strived to assert Cuba as an independent nation, as demonstrated with the victory in the Bay of Pigs Invasion; however, he never fully accomplished this aim, continuing to depend on their monoculture and export-oriented economy. Castro's objective for Cuba was to uphold an uncorrupted, democratic nation. However many of his actions pr ove his ideology wrong. Within the early months after he overthrew Batista, Castro made a decision with other revolutionaries to pass the Fundamental Law of the Republic in February of 1959.By passing this legislature he gave himself more legislative power as executive of the country, adding to his power to veto due to his rank as Executive of Army. Jose Cardona was replaced from his job as Head of Legislature which allowed Castro to basically become a dictator–the opposite of a democracy. The people of Cuba lost their freedoms that citizens should have in a democracy. The government began redistributing income from the urban to the rural working class. Although it created successes such as a raise in wages, a raise in purchasing power, and a decrease in unemployment, incomes were still not all equal.Land became another freedom of the people that the government decided to take away and redistribute. Large plantation estates called Latifundios were outlawed and limited to 995 acres with the Agrarian Reform Law. The INRA enforced the ARL which hurt large American owned companies like Coca Cola and Hershey’s, contributing more animosity from the U. S. Along with the Second Law of Agrarian Reform in 1963, both reforms created an agricultural system that did not produce the same amount of crop as they did pre-1959 until the late 1960s.After forming the Constitution in 1976, Castro made a government that was not very efficient and could silence any complaint with the â€Å"red tape† effect. By reorganizing the government into the military, executive committee, and communist party, the constitution made the Cuban bureaucracies contributing to a more authoritarian-like government. More and more, Castro nationalized Cuba in every aspect and Castro, having achieved an economic stability, made a Communistic dictatorship; therefore, he did not achieve his goal for a democracy in Cuba since his own regime was corrupt.Another goal that Castro had for Cu ba from 1959 to 1979 was to create a just society. One way Castro made this society was by targeting the needs of the people and providing them with an education and healthcare system. One of the biggest issues during Castro’s reign was the country’s lack of educated revolutionaries because most of the trained workers and professionals emigrated from the island. In his 1961 speech Castro proclaimed that this year would be the â€Å"Year of Education. † To some extent he did achieve this aspect of providing immediate literacy which rose from 76% to 94% in 1979.Other improvements occurred up through this first decade of Castro’s reign such as recruiting 100,000 students, the tripling of teachers, and quadrupling of schools. However, Castro did create a curriculum that would not only provide an education limited to only basic reading and writing but also indoctrinate students with the loyalty and morals of Communism. Vilma Espin, the head of The Cuban Womenà ¢â‚¬â„¢s Federation, advocated for literacy rates in the female population while also pushing for education and healthcare as well. Through Espin’s work, Castro realized that it was larger issue, thus he passed the Family Code.This law mandated equality in marriage and legitimized divorce. This law was never really enforced but women were generally happy with the gain. Gender and racial equality was an issue with which no other country in Latin America had dealt. Castro also stressed the need for a healthcare system in Cuban society in order to create a just society. His system would implement a method that trained doctors in universities around the country. Because of forming of education and healthcare systems, Castro’s aim for social justice in Cuba was achieved to some extent.Castro was not able to uphold his ideology because limited reasons. The chief reason that may have hindered him from achieving more is the on-going tensions with the U. S. and the economic con sequences from this. If the U. S. did not have the discontent toward Cuba’s regime, Cuba would have developed the revolutionized economy that they sought. If Castro had developed relations with the U. S. and given up the socialist policies, Cuba would have avoided severe U. S. tensions and the embargo altogether. The U. S. embargo on Cuba was a major influence that hindered economic prosperity and diversified agriculture.Castro focused on manipulate Cuba from his revolutionary political aims in the 26th of July Movement. Initially, he attempts to create Cuba in the ideology of a system of social justice within the broadest concept of democracy, of freedom and of human rights. Throughout his reign Castro enacted laws and promoted policies in order to create this fully independent and democratic Cuba with a just society. To the least extent, Castro fulfilled this vision during the first two decades of the revolution, and on-going tensions with the U. S. prevented Castro from ex tending his revolutionary aim.

Essay about Gender Issues of Mesopotamia - 801 Words

Gender Issues of Mesopotamia Throughout the history of our society, women have gained a certain respect and certain rights over time. Such simple aspects of life such as getting a job, voting, and even choosing who they would like to marry are things that women have fought for, for many years. At one point, these were all things that women in America and parts of Europe had no right to. Men as a whole had suppressed women and taken control of the society. Despite mass oppression in history, women have risen in society and now posses these natural rights. Back in the days of Mesopotamia, things were quite different. Women were respected for who they were and did not have to fight to gain the rights they had.†¦show more content†¦Another example, codes 151 and 152 actually show equal responsibility between both men and women: 151. If a woman who lived in a mans house made an agreement with her husband, that no creditor can arrest her, and has given a document therefor: if that man, before he married that woman, had a debt, the creditor can not hold the woman for it. But if the woman, before she entered the mans house, had contracted a debt, her creditor can not arrest her husband therefor. 152. If after the woman had entered the mans house, both contracted a debt, both must pay the merchant. 1 This example of equal responsibility shows to an extent, how women were treated respectfully within these ancient civilizations. The woman of the house has almost as much responsibility as the man. If together they accumulate a debt, both of them are to be held responsible. Evaluating Hammurabi’s Code, and determining exactly what was expected of women is very beneficial, though it isn’t sufficient enough to find out how women were treated by men. For this, we must turn to the documentation of one’s life within this time period. The story of Gilgamesh and his epic journey is a perfect example. Gilgamesh, when he is trying to tame Enkidu in the beginning of the journey, brings him a prostitute to love him. â€Å"That is Enkidu, Shamhat, show him your breasts, show him your beauty. (Ferry 8)† Gilgamesh says to Shamhat. Within this scenario, Gilgamesh is using this womanShow MoreRelatedEssay on King Hammurabi’s Efforts to Unify Mesopotamia879 Words   |  4 PagesDuring this era, ancient Mesopotamia was under the rule of theocratic monarchies. It was believed that the sole ruler was governing specifically for the gods and catering to their wishes. Mesopotamians were polytheistic, or worshippers of multiple gods, and extremely devout in their faith. They believed that the gods determined all situations and occurrences. As a ruler, King Hammurabi found Mesopotamia to be tremendously divided. 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Race and Ethnicity in Sociology

The sociology of race and ethnicity is a large and vibrant subfield within sociology in which researchers and theorists focus on the ways that social, political, and economic relations interact with race and ethnicity in a given society, region, or community. Topics and methods in this subfield are wide-ranging, and the development of the field dates back to the early 20th century. Introduction to the Subfield The sociology of race and ethnicity began to take shape in the late 19th century. The American sociologist W.E.B. Du Bois, who was the first African American to earn a Ph.D. at Harvard, is credited with pioneering the subfield within the United States with his famous and still widely taught books The Souls of Black Folk  and Black Reconstruction. However, the subfield today differs greatly from its early stages. When early American sociologists focused on race and ethnicity, du Bois excepted, they tended to focus on the concepts of integration, acculturation, and assimilation, in keeping with the view of the U.S. as a melting pot into which difference should be absorbed. Concerns during the early 20th century were for teaching those who differed visually, culturally, or linguistically from the white  Anglo-Saxon norms how to think, speak, and act in accordance with them. This approach to studying race and ethnicity framed those who were not white Anglo-Saxon as problems that needed to be solved  and was directed primarily by sociologists who were white men from middle to upper-class families. As more people of color and women became social scientists throughout the twentieth century, they created and developed theoretical perspectives that differed from the normative approach in sociology, and crafted research from different standpoints that shifted the analytic focus from particular populations to social relations and the social system. Today, sociologists within the subfield of race and ethnicity focus on areas including racial and ethnic identities, social relations and interactions within and across racial and ethnic lines, racial and ethnic stratification and segregation, culture and worldview and how these relate to race, and power and inequality relative to majority and minority statuses in society. But, before we learn more about this subfield, its important to have a clear understanding of how sociologists define race and ethnicity. How Sociologists Define Race and Ethnicity Most readers have an understanding of what race is and means in U.S. society. Race refers to how we categorize people by skin color and phenotype—certain physical facial features that are shared to a certain degree by a given group. Common racial categories that most people would recognize in the U.S. include Black, white, Asian, Latino, and American Indian. But the tricky bit is that there is absolutely no biological determinant of race. Instead, sociologists recognize that our idea of race and racial categories are social constructs that are unstable and shifting, and that can be seen to have changed over time in relation to historical and political events. We also recognize race as defined in large part by context. Black means something different in the U.S. versus Brazil versus India, for example, and this difference in meaning manifests in real differences in social experience. Ethnicity is likely a bit more difficult to explain for most people. Unlike race, which is primarily seen and understood on the basis of skin color and phenotype, ethnicity does not necessarily provide visual cues. Instead, it is based on a shared common culture, including elements like language, religion, art, music, and literature,  and norms, customs, practices, and history.  An ethnic group does not exist simply because of the common national or cultural origins of the group, however. They develop because of their unique historical and social experiences, which become the basis for the group’s ethnic identity. For example, prior to immigration to the U.S., Italians did not think of themselves as a distinct group with common interests and experiences. However, the process of immigration and the experiences they faced as a group in their new homeland, including  discrimination, created a new ethnic identity. Within a racial group, there can be several ethnic groups. For example, a white American might identify as part of a variety of ethnic groups including German American, Polish American, and Irish American, among others. Other examples of ethnic groups within the U.S. include and are not limited to Creole, Caribbean Americans, Mexican Americans, and  Arab Americans. Key Concepts and Theories of Race and Ethnicity Early American sociologist W.E.B. du Bois offered one of the most important and lasting theoretical contributions to the sociology of race and ethnicity when he presented the concept of double-consciousness in  The Souls of Black Folk. This concept refers to the way in which people of color in predominantly white societies and spaces and ethnic minorities have the experience of seeing themselves through their own eyes, but also of seeing themselves as other through the eyes of the white majority. This results in a conflicting and often distressing experience of the process of identity formation.Racial formation theory, developed by sociologists Howard Winant and Michael Omi, frames race as an unstable, ever-evolving social construct that is tied to historical and political events. They assert that differing racial projects that seek to define race and racial categories are engaged in constant competition to give the dominant meaning to race. Their theory illuminates how race has be en and continues to be a politically contested social construct, upon which is granted access to rights, resources, and power.The theory of systemic racism, developed by sociologist Joe Feagin, is an important and widely used theory of race and racism that has gained particular traction since the rise of the BlackLivesMatter movement. Feagins theory, rooted in historical documentation, asserts that racism was built into the very foundation of U.S. society and that it now exists within every aspect of society. Connecting economic wealth and impoverishment, politics and disenfranchisement, racism within institutions like schools and media, to racist assumptions and ideas, Feagins theory is a roadmap for understanding the origins of racism in the U.S., how it operates today, and what anti-racist activists can do to combat it.Initially articulated by legal scholar Kimberlà © Williams Crenshaw, the concept of intersectionality would become a cornerstone of the theory of sociologist Patr icia Hill Collins, and an important theoretical concept of all sociological approaches to race and ethnicity within the academy today. The concept refers to the necessity of considering the different social categories and forces that race interacts with as people experience the world, including but not limited to gender, economic class, sexuality, culture, ethnicity, and ability. Research Topics Sociologists of race and ethnicity study just about anything one could imagine, but some core topics within the subfield include the following. How race and ethnicity shape the process of identity formation for individuals and communities, like for example the complicated process of creating a racial identity as a mixed-race person.How racism manifests in everyday life and shapes ones life trajectory. For example, how racial biases affect student-teacher interaction from elementary school to university and graduate school, and how skin color affects perceived intelligence.The relationship between race and the police and the criminal justice system, including how race and racism affect policing tactics and arrest rates, sentencing, incarceration rates, and life after parole. In 2014, many sociologists came together to create The Ferguson Syllabus, which is a reading list and teaching tool for understanding the long history and contemporary aspects of these issues.The long history and contemporary problem of residential segregation, and how this affects  everything from family wealth, economic well-being, education, access t o healthy food, and health.Since the 1980s,  whiteness has been an important topic of study within the sociology of race and ethnicity. Up until that point, it was largely neglected academically  because it was simply seen as the norm against which difference was measured. Thanks largely to scholar Peggy McIntosh, who helped people understand the concept of white privilege, what it means to be white, who can be considered white, and how whiteness fits within the social structure is a vibrant topic of study. The sociology of race and ethnicity is a vibrant subfield that hosts a wealth and diversity of research and theory. The  American Sociological Association  even has a webpage devoted to it. Updated  by Nicki Lisa Cole, Ph.D.