Thought & Action: multitasking, the civil class, and the scholarly voice

2008 is drawing to a close, but not before I could read the autumn'08 issue of Thought & Action, the National Education Association's journal of higher education. This issue contains three articles related to technology (or at least modern life) and education. Although they're not presented as such, all three seem related to me.

You Say Multitasking Like It's a Good Thing

In the first article1, Professor Charles J. Abaté reviews with a skeptical eye the issue of "multitasking." He identifies three myths related to multitasking that he refutes with evidence from psychology: (1) multitasking saves time, (2) learning while multitasking is as good as learning while single tasking, and (3) the young have an advantage at multitasking. At least the first two clearly have something to say to nursing and nursing education.

Sources that I don't have time to re-find and cite here have suggested that multitasking is a skill at which women excel (or at least are better at than men) and is a professional characteristic of nursing. As Abaté suggests, this is likely not true. What's more, the suggestion that multitasking is a skill rather than a necessary evil of nursing changes the terms of the issue in a way that is likely not good for patients. The necessity for mutlitasking is something that should be reduced or rooted out systemically at the health institution level, not something that students should be indoctrinated with at the educational level. For example, at my hospital, those on the 7pm-7am shift have to do shift assessments at 7pm and again at 11pm. Charting is something that is necessarily done in snatches of time here and there. Since multitasking nurses are not actually saving time, it's an efficiency reducer and administrators should seek to reduce its incidence.

Multitasking indoctrination occurs in nursing school mostly in relation to clinicals. I have often thought that the idea of learning medications by researching patients is a bad idea, and Abaté seems to agree with me. My personal thoughts on patient research and learning medications (and lab values, pathophys, etc) have had more to do with the half-life of information and repeated sustained study, but the multitasking issue adds its own dimension--learning while multitasking does not support analytical thinking. Abaté's evidence here is a study from the 2006 Proceedings of the National Academy of Sciences. It's an interesting study with regard to the clinical learning design of nursing school and something I'll return to in a future post.

The Civil Classroom in the Age of the 'Net

In the second article2, Professor P.M. Forni addresses the problems educators face with kids these days. Just at the end of this last semester, one of the faculty at my school was describing to me how the graduating class below mine complains that all the requirements imposed on them are too stringent and should be reduced. While I have a lot of complaints of my own about nursing school, I have simpathy with things like the required 73 test average for passing and penalties for absence and tardiness. The way students act these days is preposterous, although to try to be fair, I often also feel the anxiety and anger that they seem to feel free to express. Forni makes several suggestions with, in my opinion, mixed usefulness:

Establish a climate of relaxed formality. Control in nursing education is a problem, but formality is not control. Nursing is quite different from other undergraduate programs in the degree of time spent together, whether students all taking the same courses or faculty spending hours at a time with students multiple days per week. The authority gap can disappear, and establishing formalized boundaries can help with this. Also, as an instructor, informality leaves you open to manipulation. If you need to be called by your first name to feel younger, a little bastard can start calling you Mrs. X to tear you down a little. I did that.

Train students to distinguish the trivial from the valuable. Forni suggests that the web-based equality of valuable and trivial material means each course should start from the philosophical perspective of why we are engaged in this study and, having established value, show students how to differentiate good and bad web sources.

Sell your product and yourself. Forni distinguishes the cultures of knowledge retention and knowledge retrieval. This is actually a really big deal, and I confess to being one of the "bad" students in this regard. I depend on lab values and medication information being available at my fingertips. Forni makes the point that knowledge retention is necessary for future learning. In order to make analytical connections, you have to actually remember. I agree.

However, Forni fails to note that this point does not solve the problem of why the student has to sit in a class. Retained knowledge can be tested remotely and gleaned from books and the web without classroom attendance. What is the professor's role? Forni doesn't say exactly.

Let's face it. The modern education system was designed in a time when knowledge was passed from person to person. That time is passed. Either professors bring something extra to the classroom or they are obsolete. Bad professors bring props and humor. Good professors bring illustrative anecdotes and try to identify the areas where these specific students are having trouble.

Stipulate a fair covenant. I think this suggestion is rather poor. I had a nursing professor who did this and then felt she couldn't make a change in the syllabus that both she and the class wanted--duh!

A mixed bag for the road. Here, Forni implies that instructors should seek to diminish the digital divide between themselves and students. I have mixed feelings about this. It's all right as long as two things are kept in mind: (a) making things fancy won't cut it and (b) web-based material still needs to be structured. Filling up PowerPoints with nice backgrounds and ClipArt is not learning how to use PowerPoint effectively. Putting up an extranet site for a course that's full of broken links and files too large to view quickly is taking a step back, not forward.

More on civility from Forni at Johns Hopkins website.

Scholarly Voice and Professional Identity in the Internet Age

Professor Douglas Harrison [LinkedIn] teaches English and also blogs on Southern gospel music. In the third article3, he addresses working in "mixed modes" on his blog (posting things with an academic, critical voice and also trivial and personal things) and suggests that academic blogging should no longer be seen as something to undermine a professional academic career. The points here about niche audiences, forming new intellectual communities, and personal enrichment will be familiar to those who have used the Interwebs since about 2000. The one thing that really strikes me, though, is the reference to an academic who says blogging takes up more of the time he used to spend watching TV and reading mystery novels. Spending all one's time thinking about one's academic field does not strike me as a good thing.

  1. Charles Abaté (2008). You say multitasking like it's a good thing. Thought & Action, 24, 7-15

  2. P.M. Forni (2008). The civil classroom in the age of the Net. Thought & Action, 24, 15-22

  3. D. Harrison (2008). Scholarly oice and professional identity in the Internet age. Thought & Action, 24, 23-34

Home Health: water your Christmas tree

Greetings loyal readers. I've taken some days off here for Christmas, but now I'm back! Tonight, December 28th, we enter the 4th day of Christmas. For those of you who don't know, the "12 days of Christmas" song refers to an actual calendar period stretching from December 25th (Christmas) to January 6th (Epiphany, which commemorates the visitation by the three wise men). Epiphany, it seems to me, actually adds an eschatological dimension to Christmas, but let's not drift into theology here...

What I really want to mention is the importance of watering your Christmas tree. In this age of iron, many people have moved over to fake trees, but some still purchase the real thing (and a select few cut it down themselves). If you are one of these, please note the videos below which demonstrate the utility of keeping your tree watered.

As you may have heard in your hospital before, you're not supposed to try to put out fires larger than a television set (or old-style computer monitor). The first video shows a Christmas tree fire enlarging beyond that point in about 3 seconds. The second video shows, I believe, the difference in burning between a dry and a moist Christmas tree.

You wouldn't let your patients get dehydrated, don't let it happen to their Christmas trees, either!

Heart bypass as hypothermia treatment

We received a "cool" admission the other day in the Step-Down unit at CVPH. Normally, I wouldn't be able to mention this because of HIPAA laws, but it was written up in our local newspaper, so let me simply repeat what's already out there:

PLATTSBURGH -- On Christmas Eve, Merrill Sartwell will turn 84 years old.

He almost didn't make it.

"I guess I'm a miracle baby," Sartwell said from his comfortable bed in the Intensive Care Unit at CVPH Medical Center.

Sartwell went from his Peru home into the woods in Clintonville to check on a few things at a tool shed Sunday.

His vehicle got stuck, and he started walking out of the woods. But he got tired and sat down for a moment to catch his breath and fell asleep.

He wasn't found until the next day, when a logger driving by noticed something and went to check it out.

Sartwell's body temperature had dropped to a dangerous low of about 80 degrees Fahrenheit.

He was brought to the CVPH Emergency Room where Dr. Russell Hartung began treatment. Hartung consulted with cardiovascular surgeon Dr. Albert Abbott.

After a CAT scan to determine if Sartwell had fallen and hit his head, Abbott put Sartwell on a heart-lung bypass machine.

The machine, hooked up to a main artery in Sartwell's neck, actually warmed his blood up to a safe level in just under an hour.

"This procedure works very well for severe cases of hypothermia," Abbott said.

"It helps to have the right patient."

A few days later, Sartwell was resting comfortably and giving his nurses a hard time -- with a smile, of course.

"They've been treating me very well here," Sartwell said Thursday.

"But that's why I pay my taxes."

Sartwell doesn't remember exactly what happened to him, but he is grateful for the help he received.

"I guess I went a little brain dead," he said.

"That was quite an experience, but I wouldn't want to go through it again."

Sartwell was dressed in cotton pants, boots and a regular jacket.

"If I had known I was going to stay overnight I would have dressed better," he joked.

Dr. Abbott was pleased to see his patient doing so well.

"I'm glad to see it turn out this way," he said.

"It's important for people to know that we have this technology. This is the North Country, and a lot of people are outside in the cold, and this sort of thing does happen."

'Rod's mom, RIP

This photo is from my Flickr stream and is one of my great co-workers (as opposed to my not-so-great co-workers, of which there are enough). His mother died recently. Because our local paper wasn't on top of things, the online obituary notice for Linda Lamica wasn't available at the time of the funeral, but it is now:

TUPPER LAKE — Linda Mary Lamica, 59, of Plattsburgh and formerly of Tupper Lake, died peacefully with family at her side Wednesday, Nov. 19, 2008, at CVPH in Plattsburgh after a brief battle with cancer. Linda was born May 23, 1949, in Tupper Lake, the daughter of Irvin and Rita (Grenier) Lamica.

She attended Holy Ghost Academy until her junior year and with the school closure, transferred to Pius in Saranac Lake, graduating in 1967. She then went on to attend CCBI in Syracuse. She worked mainly in Social Security benefits and lived in the Syracuse area the majority of her career. She had a variety of interests, including traveling, skiing, snowmobiling, crocheting and other crafts.

She is survived by one son, Jared Lancor and his wife Erin of Plattsburgh; two sisters, Anne Marie Bedore and her husband Glenn of Tupper Lake, Jeanne Lamica of Plainfield, Vt.; two brothers, the Rev. Alan Lamica of Saranac Lake and John Lamica and his wife Dina of Tupper Lake; nieces and nephews who include Emily Churco of Buffalo, Jesse Bedore of Tupper Lake, Kaley Cook and Kyle Cook.

She was predeceased by her parents in 2007.

Calling hours will be held from 10 to 11:45 a.m. Saturday, Nov. 22, at the Stuart-Fortune-Keough Funeral Home in Tupper Lake. A Mass of Christian burial will be celebrated at noon at St. Alphonsus Church with Father Alan Lamica officiating. Burial will be in the parish cemetery.

Those wishing to make memorial contributions are asked to consider the American Cancer Society or High Peaks Hospice.

Online condolences may be made at

Virology presentation: chlamydiaphage chp2

For my final presentation in Bio416, I presented all the research I could find on Chlamydiaphage Chp2. Hopefully, I'll be writing more on this in the next week or two as another installment of ResearchBlogging...


Vogue Paris 2009 calendar: sexy or dumb?

I've never understood the attraction for some men in the sexy nurse image. I've never thought nurses were sexy. The sexy women I've met who were nurses either wanted to get out of nursing or weren't very good nurses. Anyhow, Vogue Paris has released their 2009 calendar with the following (dumb) image. Via

I mean, honestly, if you were going to have a nurse fantasy, wouldn't it be one where the nurse was actually acting like a nurse?

Finals (semester?) over: we take this opportunity...

Monday morning was the final exam in Nur435 Psychiatric Nursing. Monday afternoon was a presentation on my Nur427 Nursing Research project. Monday evening and all day yesterday, I worked on the term paper and "journey paper" for Nur428 Management/Leadership.

Hopefully, all my nursing is over for the semester. I only needed to get about 25% of the points on my research project, so I should be okay, although the literature review and ethical/legal components that I left to my partner ended up being weighted most in the grade. There's also the possibility that I could fall on my face in Management/Leadership. The class was very disorganized, and I'm not sure what the instructions for the term paper were even after asking the instructor to clarify three different times (I ended up just using the grading rubric as an outline, which makes a piss-poor paper).

Now all I have left is a presentation for Bio416 Virology. It could go well except that we've had about a month to work on it and I have to do it all today and tomorrow morning. As the NA's would say at work, "oh shit balls..."

Anyhow, I take this opportunity to provide a little "Bach break" from finals by way of David Post's son. Via Volokh Conspiracy...

Nursing at Pearl Harbor

In a panic for a paper due tomorrow in Nur428 Management, I almost forgot that today is Pearl Harbor Day--commemoration of the attack on the US Navy base at Pearl Harbor, Hawaii, on December 7, 1941. Over at The Corner, Stephen Spruiell has visited a gathering of Pearl Harbor veterans in Texas...
...85-year-old Frank Curre Jr., agrees to talk to me. His story is harrowing. He was only 18 when his ship, the U.S.S. Tennessee, was bombed in the attack. He saw the U.S.S. Arizona explode when a bomb ignited its ammunition magazine. He describes the resulting carnage as “like someone threw up a box of popcorn into the air, the popcorn was the men coming off her.”

Of course, nurses were at Pearl Harbor, too. Lieutenant Ruth Erickson remembers...
The first patient came into our dressing room at 8:25 a.m. with a large opening in his abdomen and bleeding profusely. They started an intravenous and transfusion. I can still see the tremor of Dr. Brunson's hand as he picked up the needle. Everyone was terrified. The patient died within the hour.

Then the burned patients streamed in. The USS Nevada (BB-36) had managed some steam and attempted to get out of the channel. They were unable to make it and went aground on Hospital Point right near the hospital. There was heavy oil on the water and the men dived off the ship and swam through these waters to Hospital Point, not too great a distance, but when one is burned... How they ever managed, I'll never know.

The tropical dress at the time was white t-shirts and shorts. The burns began where the pants ended. Bared arms and faces were plentiful. Personnel retrieved a supply of flit guns from stock. We filled these with tannic acid to spray burned bodies. Then we gave these gravely injured patients sedatives for their intense pain.

Orthopedic patients were eased out of their beds with no time for linen changes as an unending stream of burn patients continued until mid afternoon. A doctor, who several days before had renal surgery and was still convalescing, got out of his bed and began to assist the other doctors.

Video of neutrophil chasing bacterium

UPDATE 12/7 : looking at this again, I realize I accepted uncritically the fact that this was a neutrophil. Look at the tail. Perhaps it isn't. I don't really know...

This is really amazing...

via Greg Laden's blog

Discover article on men's health dx

Discover has an interesting article that recounts the diagnosis of a man with diffuse neurological symptoms. From 29, Male, and Dangerously Ill:

The signs were not good. Photophobia —light bothering the eyes—is a classic symptom of infection or inflammation of the meninges, the lining of the brain. Ataxic gait—inability to walk a straight line—suggests damage to the cerebellum, the brain’s coordination center. Most odd and worrisome was the difficulty urinating. That suggested a tumor or infection in the spinal cord.

The symptoms were all over the neurological map. I got off the phone and found the charge nurse. “Jeannie, Dr. Giron is sending a patient down. Possible meningitis. We need an isolation room.”

Nursing research final, part 2

And here is the second essay from the final...

Discuss the distinction between research utilization and evidence-based practice. What do you see as your role in applying research to practice? How will you recognize the need for further research related to a patient-care scenario and how will you know when any given research is ready for utilization? What are some barriers to RU and EBP you may encounter and strategies for overcoming those barriers? (10 possible points)

Research utilization (RU) and evidence-based practice (EBP) may be presented as the same thing in some sources, but they are not. One way to think of the difference between RU and EBP is to consider RU as a technical process and EBP as a paradigm of the clinical environment. RU refers to the process of applying the results of studies to problems in real-world circumstances. The definition of "problem" here can be quite flexible, and RU has been described as existing in a continuum from narrow approaches such as changing protocols to broad approaches such as changing staff attitudes to problems-solving (Polit & Beck, 2006). EBP refers to a way of conducting oneself or one's staff in a setting of continuous patient care such as a hospital or public health venue. It means making patient care decisions in light of the best possible empirical knowledge, and it is essentially a way of defining the relationship between health care and the social and natural sciences.

One way to conceive of the difference between RU and EBP is to consider what types of questions are asked under these two approaches. Strictly speaking, RU might not be a type of questioning, but could be something that could be used in the process of answering questions. However, RU could also represent an approach to questions that starts from the science: "Here is some research. What does it mean for us?" EBP represents an approach to questions that starts from clinical problem-solving: "Here is a problem. What research exists for us?"

Between the two approaches of RU and EBP, nurses do not actually have to choose. Besides titled positions (such as CNS) dedicated to performance review, the role of a nurse applying research to practice is mutlifaceted and can be conceptualized by looking at the two types of questions above. The EBP question starts from a clinical situation, so it implies that the nurse is in a practice situation already. The RU question starts from research, which would be found in perusing journals or databases, so it implies that the nurse is engaged with the research outside the clinical situation. EBP is a theoretical approach to patient care, but RU is part of the professional aspect of nursing--continuing self-education and keeping up with the latest knowledge in the profession by reading journals. The role of the nurse who subscribes to EBP is to define problems during practice and approach the literature in off hours to define solutions to those problems. The role of the nurse as professional is to read broadly and maintain education related to the latest science.

In order to succeed with either EBP or RU, the nurse must be familiar with the specific jargon and methodologies used in research studies. For nurses engaged in EBP, it is necessary to know when the research that has been found is adequate to solve the clinical problems and when further research is needed. For nurses engaged in RU, it is necessary to know when specific studies are appropriate for being brought to the practice setting. Together, these are the skills necessary to evaluate evidence. Questions must be asked: Was the sample representative? Was the questionnaire valid and reliable? Did the interviewer adequately control for her own preconceptions? Were the results significant enough (p) to be meaningful?

One would hope that the hard work of reading the methodology closely would be done by journal editors and peer reviewers, but that is not always the case as some research might not be adequate to change practice but might be publishable for its value in suggesting new directions for research. To make things easier for those using research, systematic strategies have been devised such as Cochrane-based evidence hierarchies and multiple practical models (e.g., Stetler and Ottawa). These provide guidance to the reader on the quality of studies and the method for decision-making about studies. In the end, however, the nurse is left to contend in her own local health-care setting with her education and wits.

And wits the nurse may need aplenty if she is to overcome some of the barriers to RU and EBP. Polit and Beck (2006), describe a number of these in the eighteenth chapter of their text. The barriers described there run the gamut from individuals to organizations and inertia to intention. Examples include a lack of education for research skills on the part of nurses, lack of financial incentives on the part of hospitals, and the perceived threat of those whose practice must change in the face of evidence. But one possible barrier is not addressed in this chapter. Does the profession of nursing, by its nature, appeal to people who are resistant to research review?

In talking with ICU and PCU nurses at a local hospital, themes emerged of impatience with and disinterest in research, as well as social marginalization of nurses who were interested in such "intellectual" pursuits. Comments were made such as "I'm a hands-on learner" and "I wanted to be a nurse so I would be doing something." EBP has definite advantages for patients and RU is a clearly important component of patient care, but the skills and psychology of administering bedside care and pursuing research represent a type of task-switching that other professions are not asked to do.

This barrier is a difficult one to overcome since it relates not only to nurses' conceptions of the profession of nursing but also to their own identities. It is a shame to say that the most consistently successful and implementable idea would probably be a transactional solution related to nurses' job responsibilities. Providing more personal time or breaks in exchange for participation in journal clubs or study participation would force nurses to describe their responsibilities differently. A more deeply successful idea would be a transformational solution. Unfortunately, this is less implementable since transformational leadership so often requires inspiration itself.


Polit, D.F., & Beck, C.T. (2006). Essentials of nursing research: Methods, appraisal, and utilization (6th ed.). New York: Lippincott Williams & Wilkins.

Bioweapon attack in five years

From the AP, here:

WASHINGTON (AP) — A bipartisan commission is asserting the country should expect a terrorist attack using nuclear or biological weapons sometime in the next five years.

The report, which is scheduled to be publicly released on Wednesday, suggests that the incoming administration of President-elect Barack Obama should improve the capability of the United States to counter such an attack and to prepare if necessary for germ warfare.

The report was written by the Commission on the Prevention of WMD Proliferation and Terrorism. Among other things, it concluded: "Our margin of safety is shrinking, not growing."

The commission also is encouraging the new White House to appoint a National Security Council official to exclusively coordinate U.S. intelligence and foreign policy on combating the spread of nuclear and biological weapons.

Nursing research final, part 1

I'm not sure why anyone would want to read this, but here is the first essay from my Nur427 Nursing Research take-home (mentioned in the last post)...

One of the identified essentials of baccalaureate nursing education is "scholarship for evidence based practice" with a goal of promoting "professional nursing practice grounded in the translation of current evidence into one's practice". In what ways has your nursing education at Plattsburgh prepared you to consider and utilize research in your future practice? (5 possible points)

The advantages of employing baccalaureate-prepared nurses in the hospital care setting has been demonstrated through lower rates of patient mortality. This is not simply a matter of extra training since the baccalaureate program uses a different emphasis in the preparation of nurses. Specifically, baccalaureate programs like Plattsburgh State's focus on a broader, scholarly approach to education that emphasizes participation in nursing scholarship post-graduation. Scholarship should facilitate the integration of evidence and patient care practices. To help examine how Plattsburgh has prepared students to integrate evidence into practice, a rubric is proposed based on distinguishing, within the educational context, ubiquitous integration from transparent analysis and intellectual exploration from practical application.

This proposal could be represented by a table in which integration and analysis on one axis would each intersect with exploration and application on another. Integration in this context refers to bringing principles of research and scholarship into the pursuit of knowledge aimed at non-scholarly activity. Analysis refers to the investigation of research and scholarship on its own terms. Exploration refers to the mental, abstract activities normally associated with classroom learning, while application here refers to learning through the experiences outside the classroom that require problem-solving in a non-academic environment.

At the intersection of analysis and exploration is the most straight-forward type of learning associated with research. The primary item in this field is the Nur427 Nursing Research course. The content of this course is designed to provide an introduction to tools--if not for the purpose of performing research, at least for the purpose of reading and understanding research. However, readings in the course have gone beyond research tools and touched on the history and theory of using research in nursing practice. In this way, the course has given structure and direction for the baccalaureate-level practice of nursing.

Nur427 would not be the only item in the field of analysis-exploration, however. General education courses such as statistics and introduction to sociology also belong. Like Nur427, statistics focused on some of the tools of research. Sociology provided an introduction to some of the theoretical underpinnings of research, which in turn provides direction for identifying research problems.

The integration and exploration field is represented by the type of work that was done in Nursing Fundamentals and Care of the Adult I. In those courses, research papers were assigned for which students were asked to summate the state of science on a nursing topic. Like Nur427, the work in these courses was aimed at an understanding of the research utilization process--especially, in these cases, the processes associated with reviewing literature. Unlike Nur427, the intellectualization of the assignments' purposes was integrated into the process of carrying out the assignments rather than being the assignments' content.

Toward the end of Care of the Adult I and moving on into Care of the Adult II, the course assignments became focused on Nursing Care Plans and the focus shifted to real patients. This work belongs in the field of integration and application. Evidence and nursing research was a key component of the creation of Nursing Care Plans, but its use never became the point of planning. It remained in the background, and the focus remained on solving the real problems that were presented to students by real patients in clinical rotations.

The final field in this table would be analysis and application. Should it be populated with anything? If it is like the other analysis field, it should include courses or assignments that are transparently and reflectively based on learning about research. And if it is like the other application field, it should be based on something like a clinical or field experience. The model would be a course about research usage that used real patients or real practice situations as a basis for exploring the process of research utilization. At PSU, the closest course to this model would be the Management/Leadership course.

One issue that, it seems, should be addressed in the transition of all nursing education to four-year programs is the place of a Management course in the curriculum. Educating all nurses for management, which is what would happen if the BSN/ADN distinction disappeared, is not resource-efficient. It would make more sense to substitute a Practice Review/Research Utilization course that would have a clinical component that would focus on how, as a floor nurse or specialist such as a WOCN or CNS, an individual uses research.

Anyhow, this table format does a good job of introducing formal aspects of the way PSU has prepared students to integrate evidence into practice. However, it does not capture the experience of the total liberal arts education. Extra-curricular events such as the Nomadicare presentation on nursing in Mongolia give salience to features of nursing research such as bracketing. And the experience of being in the university setting with professors who have or are engaged in their own production of evidenciary knowledge is exposure to leadership in this area.

Using GoogleBooks to assist with take-home exam

For Nur427 Nursing Research, we were given a take-home exam (vignettes and short-answer, thank God!) to be completed over Thanksgiving break. There were a few terms I wasn't really sure how to interpret in the context of the questions: in particular, "operationalize"--not a hard concept in research, but one we hadn't discussed and I wasn't familiar with. The index wasn't helpful as it only pointed to the glossary, which was inadequate. What to do?

Well, I got the idea of looking in GoogleBooks to see if the Index was an inadequate index. Sure enough, Essentials of Nursing Research (6th ed.) is available on GoogleBooks. And if you type in the term "operationalize" or "operationalized" in the upper-right-side search box, it turns out that the term shows up in many more places than the Index indexes.

I think this demonstrates another great (free) educational use of Google. Can't find something in your textbook? Use GoogleBooks.