Macrocognitive functions (MCFs)’ definitions, inter-rater reliability (IRR) and prevalence
| Categories and subcategories of MCFs | Definition | IRR | Percentage of verbalisations* |
| Monitoring | Tracking implementation progress to maintain situation awareness or discovering that a situation is deviating from its expected course.13 14 | 0.64c | 44% |
| Tracking adherence to IPC protocol | Actively thinking about when or how one should do things to prevent later infection in a patient or healthcare worker including the adequacy of an IPC protocol and detecting deviations from an IPC protocol. | 0.30a | (62%) |
| Detecting problem of difficulty using PPE | Experiences trouble while using PPE. | 0.96d | (8%) |
| Detecting a contamination event | Recognising that something, which is not normally contaminated, is no longer sterile or clean. | 0.59b | (26%) |
| Detecting problem of having limited resources | Recognising that resources are insufficient for the task at hand. | 0.94d | (7%) |
| Detecting problem of lack of knowledge | Recognising that one does not know how to perform a procedure or whether to perform a procedure in a clean or in a sterile manner. | 0.92d | (3%) |
| Planning | ‘Generating [or] adapting methods for action to transform current state into desired future state’ (Mickelson et al,13 p. 7). | 0.88d | 13% |
| Sequencing patients | Thinking about the order to care for patients. | 0.95d | (6%) |
| Sequencing tasks | Thinking about the order that tasks should be completed for a patient. | 0.62c | (27%) |
| Sequencing steps in a task | Thinking about the order of steps or what steps to take to complete a task correctly and efficiently regardless of whether the participant has started a task. | 0.55b | (33%) |
| Preparing for task | Before starting a task, thinking about how or taking actions to set up for a task. | 0.50b | (37%) |
| Sensemaking | ‘A deliberate and systematic attempt to find a coherent, conceptual situational understanding [or] acquire new knowledge’ (Holtrop et al,14 p. 2); this understanding can be used to explain previous events or anticipate future events.63 | 0.84d | 17% |
| Assessing what resources are available for applying IPC practices | Assessing what resources are available for applying IPC practices or where resources are located. | 0.77c | (32%) |
| Anticipating a contamination event in a situation | Foreseeing a contamination event that will, or could, occur in a situation. That is, anticipating that something, which is not normally contaminated, will or could become soiled or dirty. | 0.59b | (27%) |
| Identifying appropriate IPC practices in a situation | Identifying the proper action to take or how to perform that action in a situation, from an IPC perspective. | 0.43b | (34%) |
| Assessing whether a surface is sterile, clean or dirty | Determining whether a surface is sterile, clean or dirty. This does not include detecting a contamination event or actively tracking whether a surface is currently sterile, clean or dirty. | 0.86d | (8%) |
| Decision making | The cognitive process of choosing and committing to one or more options or courses of actions.13 15 | 0.59b | 49% |
| Try to reduce or resolve uncertainty | When deciding what to do under uncertainty, try to lessen one’s uncertainty by collecting additional information or thinking through an approach. | 0.71c | (13%) |
| Accept uncertainty but proceed cautiously | When deciding what to do under uncertainty, one assumes the worst-case scenario is true and acts accordingly, instead of trying to lessen uncertainty. | 0.68c | (13%) |
| Follow a formal rule | When deciding what rule to follow in a situation, following a rule that is based on protocol, policy or best-practice. | 0.67c | (29%) |
| Follow an informal rule | When deciding what rule to follow in a situation, following a rule that deviates from a formal rule and is instead based on personal preferences, attitudes, experience or social norms. | 0.73c | (12%) |
| Compromise on the quality of an IPC practice | When deciding how to balance IPC with other constraints or priorities, finding a solution that is workable but less than ideal, from an IPC perspective. | 0.72c | (13%) |
| Sacrifice an IPC practice | When deciding how to balance IPC with other constraints or priorities, recognising the relevance of an IPC practice in a situation, but deciding against performing that practice entirely because of constraints or greater priorities. | 0.82d | (12%) |
Note: a=fair agreement; b=moderate agreement; c=substantial agreement; d=almost perfect agreement.33
*Percentages without parentheses are the percentage of all relevant verbalisations that were coded as the MCF in that row. Percentages with parentheses are the percentage of verbalisations that were coded as the subcategory for that row out of the number of verbalisations for that given MCF. As verbalisations could be coded into multiple MCF categories or subcategories, percentages may sum to >100%. Not shown is an ‘other’ subcategory for each MCF (1% of monitoring verbalisations were coded as ‘other’, 0% for planning, 6% for sensemaking, 1% for decision making) and uncategorised verbalisations (0.4% of monitoring verbalisations were not categorised, 1% for planning, 0% for sensemaking, 10% for decision making).
IPC, infection prevention and control; PPE, personal protective equipment.