Compare and contrast delirium with brief psychotic disorder. For this discussion, you will need to place particular emphasis on how comprehensive assessment could help us to arrive at the correct diagnosis for the adult/geriatric patien

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Explains how a business problem affects an organization and the consequences of not solving the problem. Describes possible solutions to a business problem and explains how each is relevant to the organization

Explains how a business problem affects an organization and the consequences of not solving the problem.Describes possible solutions to a business problem and explains how each is relevant to the organization.Explains the advantages and limitations of possible solutions to a business problem, including aspects of costs, efficiencies, and effectiveness.Supports a recommended solution to a business problem with relevant evidence, explaining the solution’s value in terms of cost, needs, organizational culture, and effectivenessExplains how a solution to a business problem will result in increased sustainability regarding profit and/or customer and employee satisfaction.Organizes content so clarity is enhanced, and all ideas flow logically with smooth transitions.This can be a business topic you would like to research to gain new insight that will be helpful to you in your current work environment, or it might simply be a business topic you are interested in. Some examples of business topics include:Workplace diversity.As you choose your topic, think about how knowing more about that topic will improve your career or advance your organization’s mission. Selecting an appropriate topic will enable you to develop a sound argument that is supported by expert knowledge.Once you have your topic, identify a problem or challenge associated with that topic. For example, if your topic is workplace diversity, the associated problem might be the challenge faced by organizations in creating a productive, healthy, and supportive work environment.Next, research your topic and problem. Locate 3–7 reputable resources on the topic. The resources you choose will help you to define the focus of your research and writing. For example, if your topic is workplace diversity and your problem is how organizations can create a productive and supportive work environment, your research may lead you to focus on how company policies can influence the work environment. Your research should also help you develop possible solutions to the problem.Now, suppose the topic and problem you have selected are also primary concerns for your organization’s leadership. You have been asked to research the topic and problem and prepare a written recommendation for the executive board that includes your evaluation of the problem.InstructionsPrepare a 3–5-page recommendation for the executive board using the following outline.Title page.Introduction: Problem Statement.Define the business problem.Importance of Problem.Explain how the business problem affects the organization and the consequences of not solving the problem.Possible Solutions.Describe possible solutions to the business problem, and explain how each is relevant to the organization.Advantages and Limitations of Possible Solutions for the Problem.Explain the advantages and limitations of possible solutions to the business problem, including aspects of costs, efficiencies, and effectiveness.Recommended Solution.Recommend a solution to the business problem, and explain how the solution is right for an organization in terms of cost, needs, organizational culture, and effectiveness.Organizational Sustainability.Explain how your recommended solution to the business problem will result in increased sustainability with regard to profit and/or customer and employee satisfaction.Conclusion.As a summary, justify and support your recommended solution to the business problem with relevant evidence and sound reasoning.References page.Your recommendation should be 3–5 pages in length, well organized, and written in clear, succinct language. Follow APA rules for attributing sources that support your analysis and conclusions.Academic Integrity and APA FormattingWhen using a direct quote (using exact or nearly exact wording), you must enclose the quoted wording in quotation marks, immediately followed by an in-text citation. The source must then be listed on your references page.When paraphrasing (using your own words to describe a non-original idea), the paraphrased idea must be immediately followed by an in-text citation, and the source must be listed on your references page.Refer to the scoring guide to ensure that your work meets the grading criteria for this assignment.Additional RequirementsYour assignment should also meet the following requirements:Written communication: Communication should be clear and well-organized, and support a central idea, with no technical writing errors, as expected of a business professional.References: References and citations are formatted in a consistent style, with a preference for using current APA style and formatting.A number of resources: Use a minimum of three scholarly resources related to the content of the assignment.Length of paper: 3–5 typed, double-spaced pages in addition to the title and references pages.Font and font-size: Times New Roman, 12 points.

 
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For this assignment, you will choose one substance or illegal drug that is prevalently being abused in our society to present to your classmates

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Theories of Social Change: . Compare and contrast two of the three theories to each other. 2. Give examples of how these theories are evidenced in today’s world. 3. What are some examples of societal change for the better? What are some examples of societal change for the worse?

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What do you think of Aristotle’s ethics? Share a few thoughts on your understanding of Aristotle’s answer to the question, “How should I live my life?” Does he make sense to you? A lot? A little? None at all? Why? Be specific

What do you think of Aristotle’s ethics? Share a few thoughts on your understanding of Aristotle’s answer to the question, “How should I live my life?” Does he make sense to you? A lot? A little? None at all? Why? Be specific. Think of a specific example, either real or imagined, that helps to illustrate your view of Aristotle’s ethics, whatever it is. (A good way to come up with an example is simply to imagine you just told someone what you think, and they say, “Hmmm…, that’s interesting, but I’m not quite sure what you mean. Can you give me an example?”)Imagine you travelled back in time to meet Aristotle. What would you say to him? What questions would you ask him if you had the chance? JUST NEEDS TO BE 50 WORDS LONG. Video to watch: https://youtu.be/FGHUcdPLpusDiscussion2. What do you think of Kant’s ethics? Share a few thoughts on your understanding of Kant’s answer to the question, “How should I live my life?” Does he make sense to you? A lot? A little? None at all? Why? Be specific. Think of a specific example, either real or imagined, that helps to illustrate your view of Kant’s ethics, whatever it is. (A good way to come up with an example is simply to imagine you just told someone what you think, and they say, “Hmmm…, that’s interesting, but I’m not quite sure what you mean. Can you give me an example?”)Imagine you travelled back in time to meet Immanuel Kant. What would you say to him? What questions would you ask him if you had the chance? JUST NEEDS TO BE 5OWORDS LONG Video to watch: https://youtu.be/06N2Uu2l1cI https://youtu.be/7Yutr5fe838Attachment for Discussion 2 is labeled Kant

 
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For this assignment, prepare a PowerPoint presentation to train mid-level managers in your organization. The focus is to help the managers design an effective training process for employees in their department

For this assignment, prepare a PowerPoint presentation to train mid-level managers in your organization. The focus is to help the managers design an effective training process for employees in their department.This presentation should simulate an actual presentation that will be delivered to the managers. You must utilize the slide notes function in PowerPoint to add speaker notes to each slide; these notes should be used in order to explain or expand on slide content as if you were actually presenting this to your audience. Include (at a minimum) the points below in your training delivery.Include an overview of the training.In conducting a needs analysis, what are the steps?What is the content of the training?How are trainer(s) selected?Identify two organizational objectives.Identify two training objectives.Identify who is the target audience for the training. What are their learning styles?Evaluate training models. Which one would you select, and why?Compare and contrast different training methods.Connect the training methods to learning styles.How will the effectiveness of the training be evaluated, and why is evaluation critical?How should managers ensure transfer of training?At the end of the PowerPoint presentation, you must have one slide with five evaluation questions to determine the effectiveness of your training.Your PowerPoint presentation must be a minimum of 15 slides in length, not counting the title or reference slides. As aforementioned, you must add slide notes or audio to the slides.You must use at least four sources to support your presentation, one of which must come from the CSU Online Library. Adhere to APA Style when creating citations and references for this assignment.

 
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Human interventions in forest or agricultural environments Choose one of the following options. Submissions must conform to the guidelines laid out in the Essay Instruction sheet. Respond to all parts of the question and support your statements with well-re

Human interventions in forest or agricultural environments
Choose one of the following options. Submissions must conform to the guidelines laid out in the
Essay Instruction sheet. Respond to all parts of the question and support your statements with
well-reasoned arguments and references.
Essay option 1. Tropical deforestation is a result of a number of human activities including
commercial logging, fuel wood collection, cattle ranching, large-scale development projects, and
agriculture.
In this essay, you are required to:
(i) Identify the most important types of activities that currently contribute to tropical
deforestation, and compare how these factors differentially influence deforestation across
regions.
(ii) Describe the environmental implications of deforestation.
(iii) Summarize the economic and/or market mechanisms used to reduce forest degradation.
Suggested sources:
1. Geist, H.J and Lambin, E.F. (2002). Proximate causes and underlying driving forces of
tropical deforestation. BioScience, 52(2), 143-150.
2. Kummer, D. and Turner, B. (1994). The human causes of deforestation in Southeast Asia.
BioScience, 44, 323-328.
3. Nepstad, D., Soares-Filho, B.S., Merry, F. et al. (2009). The end of deforestation in the
Brazilian Amazon. Science, 326, 1350-1351.
4. Rudel, T.K., Defries, R. Asner, G.P. and Laurance, W.F. (2009). Changing drivers of
deforestation and new opportunities for conservation. Conservation Biology, 23, 1396-1405.
Essay option 2. Although the green revolution led to increases in crop yield, certain negative
implications also arose. Recent narratives on the land sparing and land sharing dichotomy has
framed this tension between agricultural intensification and alternatives using agroecological
practices.
In this essay, you are required to:
i) Describe environmental and social costs associated with green revolution techniques.
ii) Given constraints in agricultural environments, explain to what extent this intensive
agricultural approach has become unsustainable.
iii) Present the environmental and social outcomes of the land sparing and land sharing approach.
Discuss which approach is optimal for achieving both biodiversity conservation and agricultural
yield, while also achieving sustainable development goals.
Suggested sources:
1. Fischer, J., Abson, D.J., Butsic, V. et al. (2014). Land sparing versus land sharing: Moving
forward. Conservation Letters 7, 149-15.
2. Pingali, PL. (2012). Green revolution: impacts, limits, and the path ahead. Proceedings of the
National Academy of Science, 109(31).
3. Singh, R.B. (2000). Environmental consequences of agricultural development: a case study
from the Green Revolution state of Haryana, India. Agriculture, Ecosystems & Environment, 82,
97-103.
4. Tomich, T., Brodt, S., Ferris, H. et al. (2011). Agroecology: A Review from a Global-Change
Perspective. Annual Review of Environment and Resources, 36,1 93–22.

 
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Creating a Culture of Change

Creating a Culture of Change
Professor Zena Moore
Professor of Nursing, Head of the School of Nursing & Midwifery ,
RCSI. Director of the SWaT Research Centre, RCSI.
Adjunct Professor, Faculty of Medicine, Nursing and Health
Sciences, Monash University, Melbourne, Australia,
Professor Department of Public Health, Faculty of Medicine and
Health Sciences, Ghent University,
Honorary Professor, Lida Institute, Shanghai, China,
Senior Tutor, University of Wales.

Outline
Why change?
Principles of change
Culture – stalled or stuck?
Attitude?
Knowledge?
Why change?
Pressure sores found in Egyptian mummies, some of which are more than 5,000 years old.
Hippocrates (460-370 B.C) described sores developing in association with paraplegia with
bladder and bowel dysfunction
During the renaissance, Ambrose Paré, wrote in his autobiography about a wounded French
aristocrat who had
a sore great as the palm of a hand on the coccyx (for he has been too
much in the bed);
1866 Nightingale wrote: “another who cannot move may die of bed-sores…….”
1877 lecture notes of Jean-Martin Charcot described his study of decubitus ulcers, writing:
decubitus ominosus, signifies not the patient in the bed, but the bed-sores supposed to
result from such positions”
Agrawal, K., & Chauhan, N. (2012). Pressure ulcers: Back to the basics. Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India, 45(2), 244–
254. http://doi.org/10.4103/0970-0358.101287
Levine, JM. Historical Perspective: The Neurotrophic Theory of Skin Ulceration. Journal of the American Geriatrics Society (JAGS) 40: 1281-1283, 1992.
Levine, JM. Historical perspective on pressure ulcers: The Decubitus Ominosus of Jean-Martin Charcot. Journal of the American Geriatrics Society (JAGS) 53: 1248-1251, 2005.

Why change?
Pressure ulcers are not a modern phenomenon; Yet…………………
BAUER, K., ROCK, K., NAZZAL, M., JONES, O. & QU, W. 2016. Pressure Ulcers in the United States’ Inpatient
Population From 2008 to 2012: Results of a Retrospective Nationwide Study. Ostomy Wound Manage, 62, 30-38.

Mean prevalence was 13.5% (SD 10%; Min 0.06%; Max 36%)
Highest prevalence: Switzerland (27.70%; n=1); Lowest: Finland (0.51%; n=2).
Conaty L, Moore Z (2016) Pressure Ulcer Prevalence: What do the European Data Tell Us? MSc Thesis, RCSI
Why change?
Why change?
Principles of Change – Lewin’s Change Model
Lewin, Kurt (June 1947). “Frontiers in Group Dynamics: Concept, Method and Reality in Social Science; Social Equilibria and Social Change”. Human
Relations. 1: 5–41.

Lippitt, R., Watson, J. and Westley, B. The Dynamics of Planned Change. New York: Harcourt, Brace and World, 1958.
Principles of change – Lippitt Model of Change
2. Assess motivation & capacity for change
1. Diagnose the problem
3. Assess change agent’s motivation & resources
4. Select progressive objective
5. Choose appropriate role of change agent
6. Maintain change
7. Terminate the helping relationship
Principles of Change – Diffusion of Innovation
Rogers EM (1983) Diffusion of Innovations. 3rd Edition. Free Press, New York.
Kotter JP (1996) The eight-stage process. In Leading Change (Kotter JP ed.). Harvard Business School Press, Boston, pp. 22-158.
Principles of change – Kotter’s 8 Stage Process
So, we are all set to go, but………..
Example
For wounds that were necrotic (7%, n=13), 38% (n=5) had a nonadherent (impregnated with soft paraffin) dressing applied;
Of the highly exuding wounds, 31% (n=10) were dressed with a
low-adherent dressing;
Of the low-exuding wounds, 31% (n=46) were dressed with an
absorptive dressing;
Of those with non-infected wounds, an antimicrobial dressing was
used as the primary wound dressing in 42% (n=61) of cases.
SKERRITT, L. & MOORE, Z. 2014. The prevalence, aetiology and management of wounds in a community care area in Ireland. Br J Community Nurs, Suppl,
S11-7.

Only 41% of those with a leg ulcer had a Doppler assessment
carried out.
Of those with venous leg ulcers, just 67% (n=36) were managed
with compression therapy (bandaging or hosiery).
Of those with diabetic foot ulcers, just 39% (n=9) were receiving
offloading as a component of their management plan.
Of those with non-infected wounds, 14% (n=64) were using silver
dressings and 78% (n=50) were using iodine-based dressings.
JORDAN O’BRIEN, J., MOORE, Z., CONNOLLY, B., CONCANNON, F., MCLAIN, N., STRAPP, H. & WILSON, P. 2016. Exploring the prevalence and
management of wounds in an urban area in Ireland. British Journal of Community Nursing, 21, S12-S19 8p.
Example
Culture – stalled or stuck?
Stuck: unable to change a situation Stalled: progress stopped
Culture – stalled or stuck?
https://www.hse.ie/eng/about/who/qid/nationalsafetyprogrammes/pressureulcerszero/ accessed 11th Jan 2019
http://www.rcsihospitals.ie/patient-care-and-treatment/, accessed 11th Jan 2019
N=1,83
1 beds
Target
0%

1. ASLAN, A. & YAVUZ VAN GIERSBERGEN, M. 2016. Nurses’ attitudes towards pressure ulcer prevention in Turkey. J Tissue Viability, 25, 66-73.
2. BEECKMAN, D., DEFLOOR, T., SCHOONHOVEN, L. & VANDERWEE, K. 2011. Knowledge and attitudes of nurses on pressure ulcer prevention: a cross-sectional multicenter study in
Belgian hospitals.
Worldviews Evid Based Nurs, 8, 166-76.
3. CHARALAMBOUS, C., KOULOURI, A., ROUPA, Z., VASILOPOULOS, A., KYRIAKOU, M. & VASILIOU, M. 2018. Knowledge and attitudes of nurses in a major public hospital in
Cyprus towards pressure ulcer prevention.
J Tissue Viability.
4. Crowder-Klobofski AG, (2013) A descriptive correlation study regarding the effect of nurses’ attitudes toward pressure ulcer risk and care. MSc Thesis, Montana State University. CrowderKlobofskiA0513.pdf (974.4Kb)
5. DEMARRE, L., VANDERWEE, K., DEFLOOR, T., VERHAEGHE, S., SCHOONHOVEN, L. & BEECKMAN, D. 2012. Pressure ulcers: knowledge and attitude of nurses and nursing
assistants in Belgian nursing homes. J Clin Nurs, 21, 1425-34.
6. DILIE, A. & MENGISTU, D. 2015. Assessment of Nurses Knowledge, Attitude, and Perceived Barriers to Expressed Pressure Ulcer Prevention Practice in Addis Ababa Government
Hospitals, Addis Ababa, Ethiopia, 2015. Advances in Nursing, 2015, 11.
7. ETAFA W, ARGAW Z, GEMECHU E, MELESE B 2018 Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC Nursing 17:14 https://doi.org/10.1186/s12912-018-0282-2
8. FLORIN, J., BAATH, C., GUNNINGBERG, L. & MARTENSSON, G. 2016. Attitudes towards pressure ulcer prevention: a psychometric evaluation of the Swedish version of the APuP
instrument.
Int Wound J, 13, 655-62.
9. Habiballah L 2018 Attitudes of intensive care nurses towards pressure ulcer prevention. Clinical Nursing Studies 6(3):1-7
10. Hamdan AB, Javison S, Tamani J, Sashidharan S, Abu Yahya O, Hamoudi B (2018) Oncology Nurses’ Beliefs, Attitudes, Perceived Barriers towards Pressure Ulcer Prevention. J Health Educ
Res Dev 2018, 6:4 DOI: 10.4172/2380-5439.1000278
11. ISLAM S, SAE-SIA APDW, KHUPANTAVEE APDN. Knowledge attitude and practice on pressure ulcer prevention among nurses in Bangladesh. Poster presentation in the 2nd international
conference on humanities and. Soc Sci. 2010
12. KADDOURAH B, ABU-SHAHEEN AK, AL-TANNIR M. Knowledge and attitudes of health professionals towards pressure ulcers at a rehabilitation hospital: a cross-sectional study. BMC
Nurs
. 2016;15:17.
13. KALLMAN, U. & SUSERUD, B. O. 2009. Knowledge, attitudes and practice among nursing staff concerning pressure ulcer prevention and treatment–a survey in a Swedish healthcare setting.
Scand J Caring Sci, 23, 334-41.
14. MOORE, Z. & PRICE, P. 2004. Nurses’ attitudes, behaviours and perceived barriers towards pressure ulcer prevention. J Clin Nurs, 13, 942-51.
15. OSENI OG, OJEWUYI OO, OTENE CI, OLAITAN PB 2018 Knowledge, attitude and practice of pressure ulcers prevention among nurses in a teaching hospital. International Journal of
Scientific Research. 7(4):37-9
16. TALLIER, P. C., REINEKE, P. R., ASADOORIAN, K., CHOONOO, J. G., CAMPO, M. & MALMGREEN-WALLEN, C. 2017. Perioperative registered nurses knowledge, attitudes,
behaviors, and barriers regarding pressure ulcer prevention in perioperative patients.
Appl Nurs Res, 36, 106-110.
17. TOLULOPE ESAN, D., AKINWANDE FASORO, A., FUNMILAYO OJO, E. & OBIALOR, B. 2018. A Descriptive, Cross-sectional Study to Assess Pressure Ulcer Knowledge and Pressure
Ulcer Prevention Attitudes of Nurses in a Tertiary Health Institution in Nigeria.
Ostomy Wound Manage, 64, 24-28.
18. TUBAISHAT, A., ALJEZAWI, M. & AL QADIRE, M. 2013. Nurses’ attitudes and perceived barriers to pressure ulcer prevention in Jordan. J Wound Care, 22, 490-7.
19. UBA, M. N., ALIH, F. I., KEVER, R .T. & LOLA, N. (2015). Knowledge, attitude and practice of nurses toward pressure ulcer prevention in University of Maiduguri Teaching Hospital, Borno
State, North-Eastern, Nigeria. International Journal of Nursing and Midwifery, 7(4), 54-60.
20. UNVER, S., FINDIK, U. Y., OZKAN, Z. K. & SURUCU, C. 2017. Attitudes of surgical nurses towards pressure ulcer prevention. J Tissue Viability, 26, 277-281.
21. YILMAZER T, TÜZER Ha, ERCİYAS A Knowledge and Attitudes Towards Prevention of Pressure Ulcer: Intensive Care Units Sample in Turkey Turkiye Klinikleri Journal of Nursing Sciences in press
10.5336/nurses.2018-63157
Attitude?
Attitudes: Results

Country Setting Number of
Nurses
Instrument Results
Belgium
Cyprus
Ethiopia
Ireland
Jordan
Nigeria
Saudi Arabia
Sweden
Turkey
USA
Cancer centre
Health care
centre
Hospital
ICU
Nursing Home
Rehabilitation
Mean 188
(SD: 147; min
29, max 553)
Moore & Price
Attitude Scale
n=13
Attitude towards
pressure ulcer
prevention (APuP)
n=7
Unknown instrument
n=1
Mean: 73
Median: 75
Mode: 78
SD: 9
Minimum: 51
Maximum: 89
71% of studies
score >70%

AssignmentTutorOnline

Attitude
Two independent influences determining an individual’s intention to perform a
behaviour.
Personal (the attitude towards the behaviour)
Social (the social pressure to perform the behaviour).
Perceived control is also an important variable in the prediction of behavioural
intention and is influenced by factors such as:
Knowledge
Skill
Time
Opportunity
Autonomy
Resources
But what about opportunity?
Knowledge
DALVAND, S., EBADI, A. & GHESHLAGH, R. G. 2018. Nurses’ knowledge on pressure injury prevention: a systematic review and metaanalysis based on the Pressure Ulcer Knowledge Assessment Tool. Clin Cosmet Investig Dermatol, 11, 613-620.
Knowledge
One of the stages of change
self-liberation, the individual’s ability to choose.
Choice occurs when there is more that one alternative
if there is only one choice then there is no freedom
Choice can create anxiety felt in taking responsibility for that choice
Choosing is made significantly more difficult when there is an
insufficient amount of information gained regarding a situation
Therefore, a tendency to cling to ritualistic practice may stem for a fear of
change due to lack of knowledge rather than an unwillingness to change.
So……stalled or stuck?
Prochaska J. O., Di Clemente C. C. (1984). The process of change in: The Transtheoretical Approach. Pp 33-44. Dow Jones-Irwin.
In conclusion
After the 41st Phase the
final Score:
Ireland 15; France 13
Why?
Everyone knew exactly
what they had to do, they
knew they needed each
other to do it and everyone
was dependent on each
other to achieve the goal

Creating a Culture of Change
Professor Zena Moore
Professor of Nursing, Head of the School of Nursing & Midwifery ,
RCSI. Director of the SWaT Research Centre, RCSI.
Adjunct Professor, Faculty of Medicine, Nursing and Health
Sciences, Monash University, Melbourne, Australia,
Professor Department of Public Health, Faculty of Medicine and
Health Sciences, Ghent University,
Honorary Professor, Lida Institute, Shanghai, China,
Senior Tutor, University of Wales.

 
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ESTD19 – ASSIGNMENT 2 Climate Risk Assessment of Public Infrastructure Projects in the

ESTD19 – ASSIGNMENT 2
Climate Risk Assessment of Public Infrastructure Projects in the

INTRODUCTION: Context

Under the new Federal/Provincial/Territorial/Municipal Climate Resilient Infrastructure
Investment Program (CRIIP), municipalities are eligible to apply for funding to higher orders of
government to support public infrastructure projects. This program applies to projectsthat are
aimed at enhancing the climate resiliency of existing infrastructure through improvements via
enhanced operations and asset management plans, as well as building new infrastructure that
is designed to a higher climate change standard. The total program has $50 Billion in its budget
allocated over the next 10 years. New capital projects costing $10 million or more are eligible
for funding, with a $3 Billion maximum (total) for any single project. Funding will be shared
between Federal, Provincial/Territorial, and Municipal governments onan equal 1/3 -1/3-1/3
basis.

The National Federation of Municipalities has endorsed this program, and the Municipal
Councillors from the City of Metropolis are eager to tap into Federal and Provincial funding to
support much needed infrastructure improvements. The Provincial Governor is also onside, but
only if the infrastructure projects are both cost effective and provides an acceptable level of
climate protection over the life of the asset. There are also expectations to deliver projects on-
time and on-budget, while using infrastructure investment to kick-start the economy in the
Post-COVID-19 era.

The City of Metropolis has been adversely impacted by extreme weather events in the past,
which has damaged infrastructure and caused disruptions in essential services. Some key
infrastructure assets are also in need of major repairs and even replacement, so the CRIIP
represents a unique opportunity to upgrade essential services. It is also an area where climate
change is projected to be significant with corresponding implications for social, economic and
eco- systems, as soon as 2050 if not before. In response to this funding opportunity, the
Mayor of Metropolis has instructed the City Manager’s Office to review infrastructure

proposals currently on file and recommend which projects should be considered by City
Council for submission to CRIP by the end of the next Federal fiscal year (March 31st, 2023).
The City’s Environment and Planning Department has been tasked to present
recommendations for up to five key infrastructure projects to Metropolis City Council at their
next budget meeting in September, 2022.

ASSIGNMENT TASK: Approach and methods

As the subject matter expert on climate resiliency employed by the City of Metropolis, you have
been tasked by the City Manager and the Director of the Environment and Planning Office to
provide a report outlining your infrastructure recommendations. A previously prepared
background document (Appendix A: Backgrounder) developed by your team to help build the
case for climate resiliency, can be used to inform and populate your report.

As there is no universal criterion for making good climate-related decisions, and essentially no
“right” or “wrong” answers, you have decided that a “team” approach is needed that follows an
open and transparent process that invites a wide range of expertise and views. Furthermore,
based on an extensive literature scan, you have decided that two sources of information would
be helpful in guiding the report, and informing the recommendations. One is the standard
Climate risk assessment process, and the other is a hierarchy of simple, complicated and
complex risks and how these shape and inform decision making as outlined in the IPCC AR5.

The climate risk assessment process is a decision support tool, based on ISO 31000, adopted in
ICLEI’s BARc tool, and follows the PIEVC Protocol. The 5-step approach to climate proofing
(becoming more climate resilient) can be applied to different spatial scales, from the national,
to regional, municipal networks and systems, and individual infrastructure assets (Figure 1).
When done correctly, the steps outline a process to engage internal and external experts,
undertake a credible and transparent risk assessment, identify and select appropriate
adaptation measures, outline an implementation strategy and plan, and build upon existing
methods to monitor and report on progress. For each step, key questions that can guide the
risk management process are provided.

Figure 1: Climate Risk Management Process

Source: adapted from ISO 31000
Guiding questions for each step along the climate risk assessment process include:
1. Screening and Scoping: Project Definition

• How is the proposed project (elements or systems of interest) vulnerable to the impacts
of current and potential extreme climate events over its life span? What are the climate
parameters of most interest to the proposed project? Is there sufficient information
available to undertake an assessment? Who are the main stakeholders that should be
engaged in the assessment (those who are impacted, and those who are responsible for
taking action)? How does the natural environment/ecosystems act as an adaptation
measure against climate change?

2. Risk Assessment: Vulnerability, Severity, Probability and Adaptive Capacity

• What are the current and historical trends in climate? How is climate projected to
change in the future and in what ways? How will this affect infrastructure/human/eco-
systems of interest? What are the root causes for projected impacts (sensitivity,
adaptive capacity, exposure)? What reasonable assumption (quantitative and
qualitative) can be made about climate change, its impacts and risk?

3. Selection of Adaptation Measures: Identifying and Selecting Adaptation Measures

• What adaptation solutions are technically feasible to address the projected climate
vulnerabilities? How might measures be described as operational, maintenance and
asset management, or replacement by new design and construction? What are the costs
and benefits of these options throughout the asset lifecycle? What are the preferred
options in the context of the project?

4. Implementation: Implementation Plan

• How are adaptation solutions integrated into the project design? Who has the capacity
to implement the selected adaption option(s)? Are there additional key stakeholders
that need to be brought into the project? Is there a need for additional capacity building
or research?

5. Monitoring and reporting: Tracking Through Key Performance Indicators

• How can progress towards vulnerability reduction be measured? How can monitoring be
used for learning? How will lessons be collected, assimilated, and used to improve
future road/transit investment and energy generation/transmission projects? Which
existing monitoring systems can be built on? Which reporting needs should be
addressed?

While the risk management process is a powerful process to assess climate risk, decision
making can be challenging as understanding interactions between climate change (and extreme
weather), systems and assets being impacted, and identifying appropriate adaptation
responses can be a daunting task. Interactions and causal relationships can be simple and
linear, they can involve multiple elements and appear complicated, and in some cases the risks
can be complex where the decision-making process demands greater attention and deeper
depths of analysis. Figure 2 outlines the hierarchy of risk types differentiating between simple,
complicated and complex, along with their respective characteristics of decision making.
Decisions around climate resiliency and adaptation are often initially perceived to be simple,
yet upon further exploration their resolution ends up following a process where relationships
are complicated, if not complex. While not perfect, this hierarchy can be a useful tool to
describe decision making and outcomes when planning for climate resiliency.

Figure 2: Hierarchy of simple, complicated, and complex risks, showing how perceived risks
multiply and become less connected with calculated risk with increasing complexity. Source:
Figure 2.2, IPCC WGII AR5, Part A: Global and Sectoral Aspects, p. 202

THE EXERCISE

As the first stage in the development of a proposal, you and your team have decided to tackle
work that supports Steps 1-3 in Figure 1i. Drawing upon the background material, provide
answers to the following questions:

Step 1: Screening and scopingii

A. Identify the objective(s) of your project.

B. What are the primary infrastructure assets of interest? Identify key components and
subcomponents that are of interest.

C. What additional infrastructure and services are secondary interests?

D. What are the historic, current, and projected climate parameters of interest and concern? What
previous extreme weather events are most relevant to this assessment and why?

E. What are the critical load thresholds of selected key infrastructure components and
operational processes that cause undesired consequences when being exceeded?

F. What are the lifecycles or design life of your key infrastructure assets or their components?
G.Identify and explain which ecosystems should be considered, that interact with the project(s)?

H. What internal stakeholders need to be engaged (e.g. asset owners, operations, planning, design
and procurement, finance, safety and business continuity, and communications) in the risk
assessment process?

I. What external stakeholders need to be engaged (e.g. Government representatives, non-
governmental organizations, sectoral trade associations, climate services organizations or companies,
Conservation authorities, community-based groups, media, etc.) in the risk assessment process?

J. Summarize your key points in the table belowiii:
Table 1: Scoping summary

Asset/System
of interest

Infrastructure
components
and design
loads

Past extreme
weather
events

Climate
parameters

Stakeholder
Groups

(e.g. internal
and external)

Ecosystems of
interest

(e.g. Alpine,
forests,
agriculture,
aquatic, etc.)

Transportation
asset #1

Transportation
asset #2…

Energy asset #1

Energy asset
#2…

Additional asset
#1

Additional asset
#2…

Step 2: Risk Assessment

A. What are the probabilities of occurrence of the climate-related hazards for current climate
conditions? How are these projected to change, under the RCP4.5, and RCP 8.5?

B. What are the consequences of climate-related impacts on the infrastructure asset
components and their ability to deliver essential services? Are these critical to the overall
health of the population and the regional economy?

C. Identify possible cumulative effects where climate-related impacts can have cascading
consequences? Provide three examples where this could lead to undesirable outcomes.

D. What groups, sectors or areas of the City of Metropolis and the Karibu River Watershed are
especially vulnerable to extreme weather conditions and climate change impacts and should be
highlighted as areas of concern for today and for the foreseeable future?

E. What are the consequences and secondary impacts on the surrounding community? What
groups or sectors could be adversely affected and severely impacted?

F. How would you describe the biggest risk that you have identified, in terms of it being simple,
complicated, or complex?

G. Summarize your key points in the table below:

Table 2: High-level identification of climate hazards and climate-related impacts

Asset/System/Components

Hazards

Potential impacts

Secondary impacts
and potential
cumulative effects

Transportation asset #1

Transportation component

Energy asset #1

Energy component

Additional Asset

Asset component

The following tables might help trigger some ideas in formulating your answers.
Table 3: Climate-related impacts in transportation infrastructure

Transport

Hazards

Potential impacts

Road

More frequent and
intense storms
including freezing rain
events

Wetter winters and drier
summers
Higher temperatures
Increased sea level
Wildfires

Ongoing freeze/thaw cycles

Increased scour of bridges
Increased instability of embankments
Damage to road surfaces and foundations
Flooding of roads
Damage to bridges and tunnels
Traffic accidents
Increased pollution levels

Rail

More frequent and
intense storms
including freezing rain
events

Wetter winters and drier
summers
Higher temperatures
Increased sea level
Wildfires

Ongoing freeze/thaw cycles

Incursion into fleet vehicles
Flooding of rail lines, increased risk to train traffic
Increased scour of bridges
Increased instability of embankments
Increased switches and signal failures
Increased rail buckling

Ports

Sea level rise
Increased storminess and
storm surges
Higher winds

Flooding of equipment
Disruption to operations
Safety issues for navigation

Airports

Increased/more intense
precipitation
Higher temperatures

Flooding of runaway
Disruption to operations
Increased risk during landing and taking off
Lift of aircraft reduced (affecting fuel use and
take-off slots)

Table 4: Climate-related impacts in energy infrastructure

Energy

Hazards

Potential impacts

Fossil fuel and
nuclear generation

Increased rainfall intensity
Sea level rise
Shoreline erosion
Higher temperatures
Reduced summer rainfall

Flooding of fossil fuel and nuclear power plants,
decommissioned nuclear sites and nuclear waste
reprocessing and storage facilities
Reduced efficiency

Reduced available water for cooling

Renewable wind
energy

Increased rainfall intensity
Reduced wind
High wind gusts
Freezing rain

Reduced efficiency
Inoperable
Sufficient damage in need of repair

Renewable solar
panels

Increased rainfall intensity
High wind gusts
Freezing rain
Higher temperatures
Freeze/thaw cycles

Reduced efficiency
Inoperable
Sufficient damage in need of repair
Thermal expansion
Safety hazard

Electricity
transmission and
distribution

Higher temperatures
Increased/more intense
precipitation
Surface water, tidal and
fluvial flooding

High wind gusts
Ground subsidence
Freeze/thaw cycles

Overheating of transmission lines
Reduced capacity of network
Flood risk to substations
Damage to overhead power lines and ancillary
infrastructure

Reduced stability of foundations and tower
structures

Fuel processing and
storage

Sea level rise
Storm surges

Flood risk to fuel storage, transporting and
processing facilities
Environmental contamination

Step 3: Adaptation measures

A. Based on a high-level risk assessment, where should the team focus on reducing vulnerability and
risks, while increasing resiliency and adaptive capacity?

B. At a high-level, how would you describe where this would apply, and the likely implications of the
following adaptation optionsandor measures moving forward:

a) retreat from high-risk areas
b) hardening of infrastructure
c) greening of infrastructure
d) changes in operations and maintenance
e) asset lifecycle management plans

f) additional risk insurance
g)emergency management response and business continuity plans
f) communications and public engagement
g) other

4.0 MARKING SCHEME

Sections 1 and 2 represent the bulk of the report and are weighed equally (8 marks each). Section
3 is more exploratory and is worth less (4 marks). The total grade is 20.

Your answers will be marked according to the standard criteria associated with essay-type
responses, supported by evidence that you include from the data and narrative provided. In
addition, your grade will reflect whether:

The student has demonstrated his or her own thinking and analysis by integrating ideas or
examples from the course materials.

Information is presented in a clear, interesting, and dynamic way. Well written answers have
a logical progression of ideas and are supported by evidence.

The student uses correct grammar, spelling, and word choice in their written work.

Assignment 2: Appendix A

Background Report:

Setting the Scene for the Climate Risk
Assessment of the Millennium Bridge, the
Karibu Power Plant and Transmission
System, and the City of Metropolis

Source: adapted from Annex 1, Hodick, B., Becher, M, Schlonvoigt, A. and B. Heine (2019) Enhancing
Climate Services for Infrastructure Investments (CSI), Trainer Handbook (Eschborn, Germany: Deutsche
Gesellschaft fur, Internationale Zusammenarbeit (GIZ) GmbH), Draft. NOT FOR CIRCULATION.

1. Casestudysetting–TheKaribuRiverWatershedandthecityof
Metropolis

1.1. Environment

The Karibu River Watershed lies in the Eastern Province of South Country. The Northern parts
of the catchment are characterized by the high Upper Mountains, gently sloping south. The Upper
Mountains have been classified an Area of Extraordinary Beauty and they are a renowned
destination for ambitious hikers and climbers in summer, while winter tourism has been gaining
attention, especially alpine skiing. However, in the past years much of the forests had been
degraded due to rapid urbanization, wildfires, and uncontrolled land-use changes, including
conversion to productive agricultural land, especially along the foothills. An expansive wildfire
wiped out an estimated 20% of the forest cover a few years ago, and another 15% last year.
Glaciers that feed the rivers have also been retreating, more rapidly in recent years. The
snowpack accumulation during the winter season can have a significant impact on river flows
during the spring freshetteand thaw, especially if the winter season has experienced heavy
snowfall. Sudden convection rainfall events in late spring and early summer have also been
known to cause extensive flooding, especially if they combine with melt waters from glaciers and
snowpack. There is concern that loss of vegetative cover from successive years of wildfires will
exacerbate the level of risk to overland and riverine flooding. While most of the flooding in the
past has been watershed based (e.g. originating from the mountains in the north), there is
increasing concern over sea level rise and the potential for coastal flooding along low lying areas
in the south.

Currently, a new dam to provide hydropower is being built at the river midstream, to supplement
power that is provided by an aging Nuclear Power plant, just upstream. One tributary adds its
waters before the Karibu River reaches the major bridge that connects both parts of the city by
providing access for vehicles and public transit. Ferry service provides an alternative route across
the Karibu River, and there are plans to consider increasing Ferry capacity and frequency of
service. Another bridge further north is also under consideration that would likely function as a
toll road, while also providing a dedicated route for a proposed second transit corridor as part of
an expanded regional transit network. Planning is underway to identify the best location and
design requirements for a new transit hub, and rail storage and maintenance facility.

Electricityis supplied by one main transmission line that serves the city core first, including the
region’s hospital, with power lines crossing the Karibu River slightly upstream from the
Millennium Bridge to serve the city’s western suburb. Strong, steady winds comparable to
“Chinooks” are a common occurrence, that can also bring dramatic shifts in temperature,
especially during the winter season. Nonetheless the City and surrounding area has been known
for its widely variable precipitation, notably costly hail storms and occasional freezing rain
events/ice storms.

1.2. The City of Metropolis

Metropolis has about 6 Million inhabitants. It is a mega city in the Eastern Province, and an area
of major importance for economic activity and social life throughout the country. Metropolis is
equipped with residential and commercial/industrial areas, green spaces for recreation,
hospitals, schools and universities, as well as vast shopping facilities covering all needs. The City’s
University-affiliated Central Hospital is the regional hub for a broader health care network, and
provides core services for Cancer, Infectious Diseases, and other specialized health issues.
Thereby, the city is of major importance for the surrounding region, especially the smaller villages
and dwellings who benefit from the services and facilities offered by the city. There is also
extensive agriculture nearby, with many productive farms providing a reliable local food supply
to the residents of Metropolis, although most of the food produced oriented for an export
market. With a harbor and a waterfront along the Ocean, the city functions as a key gateway for
the trade of goods and commodities within the region. The main port also functions to receive
Cruise ships during the summer. The road leading across the bridge is of crucial importance for
traffic, transport and overall mobility, with Ferry service playing a secondary and supporting role.

The city is also an energy center for the region, with the existing Nuclear Power plant and the
hydro plant under construction having the combined capacity to provide electricity to a growing
population and economy to at least 2050, assuminga costly refurbishment of the main existing
facility and associated transmission infrastructure. A recent consultant’s report evaluating
potential energy generation alternatives has noted the suitability of the areas where the foothills
transition to the plains for supporting wind turbines. The viability of “wind farms” requires further
analysis, as initial reaction by the agricultural community is mixed, with some seeing this as an
additional source of revenue, while others see it as a scourge on an otherwise pristine rural
landscape. There are also opportunities for the expansion of Solar Panels, either as large scale
rural based systems, or integrated with urban infrastructure such as buildings and transportation
corridors.

1.3. The Greater Metropolis Region

The Greater Metropolis Region extends beyond the City of Metropolis and encompasses an area
of approximately 10,000 km2, that is larger than some of the countries Provinces. Two smaller
urban centres exist about 50 kilometres east and west of Metropolis, each with about 100,000
population. To the northwest is the Town of Trumanville which in recent years hasbeen
attracting individuals, couples, and families with young children, who are fleeing the high housing
costs and congestion of Metropolis, while seeking more affordable housing, larger properties,
and a quieter lifestyle. The Town of Trumanville has a newly established University and is also the
home of many IT start ups. In contrast the Town of Pleasantville is located to the northeast of
Metropolis, has an older population, and a declining industrial base where traditional
manufacturing jobs have been moving offshore. Pleasantville has housing prices that are more
affordable than those found in the City of Metropolis, and offers many amenities sought after by
retirees.

Figure 1: The City of Metropolis and the Karibu River Watershed

2. InfrastructuresinFocus:TheMillenniumBridgeandtheKaribu
Electricity System

2.1. The Millennium Bridge

The Millennium Bridge has been rebuilt, after the last bridge was severely damaged during a so-
called centennial flood in 1998 and had to be taken down due to safety reasons. During that
event, people and authorities noticed that early-warning and contingency plans were not
functioning properly, leading to severe human and economic losses.

Outline of socio-economic consequences due to the bridge failure

The socio-economic impacts of this event were severe, beyond the costs of the new bridge.
During the reconstruction phase, the river crossing of people and smaller vehicles was provided
by a ferry service relatively nearby, but larger vehicles had to do a long detour of approx. 80 km
to a larger ferry further north, eventually leading to losses for fresh or frozen products.
Commuting pupils and students from the Western banks had to leave their school buses at one
side of the river, take the ferry and then climb on the next bus at the other side. The education
statistics show a decrease in the final exam grades of commuting pupils. The health statistics of
this time show a significant increase in pulmonary diseases among schoolchildren, especially in
elementary school. Medical services had to operate by helicopter if there was an emergency
case at the Western banks of Karibu River. Longer travel times of every day commuters from
their apartments on the one side of the river to their offices on theother side of the river has
caused reduced performance of companies limiting their annual turnover. The intra-regional as
well as the inter-regional trade suffered from additional costs for transport as well as from a
loss of customers and goods due to vast delays in service delivery. In the second year of
reconstruction, the local traditional market, as well as several restaurants at the river banks that
represent important tourism places, had to be closed as theexpected number of tourists had
dramatically fallen the year before causing a dramatic decrease of number of overnight stays
and has only recovered since a few years. Buses have traditionally used the Millennium Bridge
to cross the Karibu River, and since 2010 a LRT route has operated as well. Transit stations are
located on both banks and act as significant mobility hubs. Transit ridership has been increasing
steadily over the past decade, and is projected to double by 2030 as additional service is added.

The new bridge spanning Karibu River was built after the disastrous flood in 1998, with the official
opening occurring in 2000. As a result the bridge was dubbed the Millennium Bridge. Financing
the new bridge was shared by the city administration of Metropolis and the Eastern Province.
The bridge was built in adherence to the existing building codes, with some minor consideration
of climate change. In 2001, it was nominated for the prize “Innovative infrastructure of the year”
by the National Engineering Society of South State. The technical details include (bridge
components illustration courtesy of Alberta Transportation):

Engineering specifies of the bridge

Infrastructure components

Design loads

Road surface
(asphalt cement pavement)

Design temperatures: Superpave Performance Grading (PG) 64-22
(highest temperature of asphalt increased from 50°C to 60°C)

Design life = 15 years

Bridge deck

Carbon fiber reinforced concrete; design life 75 years
Drainage system designed to the historical 50-year storm
Signage capable of withstanding wind gusts up to 90 km/hr
Bridge soffit at least 1 m above the historical 50-year flood
Guard rails ungalvanized and subject to salt caused deterioration

Expansion joints

Designed up to 35 ̊C and a temperature range of 60°C

Piers and abutments

Abutments designed to resist scouring of historical 100-
year peak flow(equivalent to 4,500 m3/s), but Piers are
designed to a lower standard

Clearance of bridge deck
above high-water level

Designed for historical 100-year storm, 68 mm/2 h, and the century
flood (for a design flood of 6.5m above sea level = +4.5m above
average) caused by downstream flows and runoff from Alpine
snowpack

Figure 2: Conceptual cross-section of the Millennium Bridge

The Millennium Bridge is managed by the Metropolis City Infrastructure Authority in cooperation
with the Province’s Road Maintenance Department. The bridge will be examined concerning
functionality and maintenance in a thorough check-up in the Spring of 2023. In this process,
possible repairs or refurbishments can be programmed by taking into account climate change
risks. Currently the bridge barely meets 3 of 4 Canadian Highway Bridge Design Code standards,
but with climate change another 2 standards will likely be exceeded within 30 years.

2.2 Karibu Power Plants and Ancillary Infrastructure

The Karibu Power plant was constructed in the 1970s and experienced power disruptionscaused
by extreme weather events, including flood damage to the Transmission Substation in 1998. In
addition to flooding, the region has experienced several severe wind-storms, two ice storms in
20 years, four prolonged heat waves and droughts during the past decade, and its first recorded
tornado (F1) last year. The new Hydro dam will add generation capacity but provide limited
benefit for flood control during extreme precipitation events. Transmission Towers are under
construction that will provide the suburbs along the Western Banks of the Karibu River with a
redundant power supply from the new Hydro dam.

Outline of socio-economic consequences due to power disruptions

The socio-economic impacts caused by extreme weather events have been variable. Lower water levels
during periods of drought have coincided with water temperatures rising more than 5 ̊C above normal.
This loss of cooling efficiency above 30 ̊C has resulted in a 5% reduction in electricity generation for every
1 degree increase in temperature, at a time when hotter (air) temperatures have increased the demand
for air conditioning. Increased water flows and embankment erosion has accompanied two flood events,
in 1998 during the centennial flood and a comparable flood in 2013. The centennial flood caused major
damage to the Transmission Towers, crippled a Transmission Step-Up Transformer, and wiped out the
Utility Poles that cross the KaribuRiver, knocking out power to the Western Banks. As a result of climate
proofing of the Transmission Step-Up Transformer and Transmission Towers there was limited damage
to this ancillary infrastructure during the flood of 2013, but it is believed that they may not hold up to
larger storms, especially Transmission and Distribution Lines that are vulnerable to freezing rain
events/ice storms. Further, a F1 tornado last year knocked down Power Lines supported by the
Transmission Towers, took out some of the Utility Poles, and severely damaged the Transmission Step-
Down Transformer. The F1 tornado resulted in a widespread blackout across Metropolis, and also made
the LRT line inoperative. In 1998 the Utility Poles were replaced to the existing design standard and were
wiped out again in 2013. Plans to upgrade them to withstand a future (climate change projection to
2050) 100-year storm and flood is under review, that may be incorporated into their asset lifecycle
management plans. Fortunately, the Hospital had installed a back-up power generator after the
centennial flood that allowed the facility to provide limited health services for 48 hours during and after
the 2013 flood. There are expectations however that the Hospital must be able to function normally
during extended power outages in the future, and additional back-up power may be needed. There are
plans to provide backup power to the LRT route, with lithium batteries the preferred option over natural
gas.

Engineering specificities of the Energy system

Components

Design loads

Generating station

Design life = 100 years
Design temperatures for water cooling max. 30°C

Sustained flood protection against 90 mm in 2h rainfall and 4,500m3/s
river discharge in the basin

Step-up transformers

Design life = 75 years
Sustained flood protection against 90 mm in 2h rainfall and 4,500m3/s
river discharge in the basin

Transmission lines & towers

Designed for wind speeds max. 120 km/hr
Deign life = 75 years

Sustained flood protection up to 90 mm in 2h rainfall and 4,500m3/s river
discharge in the basin
Susceptible to ice accretion from freezing rain >25 mm

Step down transformer

Design life = 50 years
Sustained flood protection against 70 mm in 2h rainfall and 3,000m3/s
river discharge in the basin

Sub-transmission to customer

Sustained flood protection against 70 mm in 2h rainfall and 3,000 m3/s
river discharge in the basin

Utility Poles

Design life = 35 years
Sustained flood protection against 58 mm in 2 h rainfall and 2,500 m3/s
river discharge in the basin
Susceptible to high wind gusts > 90 km/h
Susceptible to ice accretion from freezing rain >12.5 mm

The Karibu Power Plants and Transmission System is managed by the Metropolis Hydro Utility
Authority in cooperation with the Province’s Ministry of Energy. The electricity Distribution
system is operated and maintained entirely by the local hydro authority. The integrity and
resiliency of the Transmission and Distribution System will be examined on a regular basis,
while the Power plant is scheduled for a major refurbishment after the Hydro Dam is up and
running. More renewables from solar and wind may also be incorporated into the energy system
in the future. Enhancement of the existing Transmission and Distribution system is planned over
time, dependent upon the availability of funds for operations and asset lifecycle management.

3. ClimateInformation

3.1. Current climate and hydrology

The following graph shows the current climate conditions in the catchment on a monthly basis
for precipitation and on a daily basis for temperature.

The recent climate for Metropolis, South State & the Karibu River Hydrology

Month

Average Monthly
Precipitation
[mm]

Average Daily
Temperature
[° C]

The Karibu’s River flow is determined by the
precipitation patterns in the catchment – in
normal years: rainfall is fairly evenly
distributed, with more snow than rain falling as
precipitation during the winter. However,
during warm winters more precipitation has
been falling as rain, rather than as snow. During
the summer months there has been a shift
towards more intense convection storm events,
along with prolonged periods of drought.

The normal level of the river is at 2m (measure
point: +1.5m above sea level), with a mean
annual discharge pf 250m3/s. The highest
recorded water level was 8.43m, the highest
recorded discharge 4,500m3/s (1998 and
2013).

Besides the natural pastures at the Eastern &
Western Bank there are no flood
control/defence mechanisms in place. Intensive
agriculture may actually exacerbate run-off into
the Karibu River watershed, increasing riverine
flood risk towards the mouth of the river, and
extending inland to the Millennium Bridge and
beyond. Increased agricultural run-off is also
leading to lower water quality conditions, and
contributing increasing amounts of silt in the
bay. As a result there is growing concern over
decreasing draught at the Port, for both cargo
and passenger vessels.

Jan

95

1

Feb

80

2

Mar

110

6

Apr

145

12

May

120

17

Jun

120

23

Jul

125

26

Aug

110

24

Sep

90

20

Oct

100

14

Nov

110

8

Dec

105

3

Annual
mean

1310 mm

13.0°C

(Mean climate normal parameters 1981-2010)

3.2. Recent observed changes in climate and hydrology

The observed changes in annual mean temperature are +1.0°C since 1970. The lower parts of the
Karibu River catchment regularly experience high water levels from April through May, due to
the spring freshette. Overall, the frequency of strong rainfall events has increased. Although, the
average amount of annual rainfall is largely unchanged, especially during El-Niño events, more
intense convection storms have been experienced in the past decade, especially during the
summer. The bridge had been partly damaged by flooding in the past, however, the last severe
damage before the one leading to the reconstruction in 1998 had been before the beginning of
the 20th century (this information had to be looked up at the town’s archives). Thus, the flood in
1998 was called a centennial flood. However, the frequency of such disruptive high-water levels
appears to be increasing and a severe flood – similar to the one in 1998 – has reoccurred once
since.

A relatively new feature are random thunderstorms accompanied by strong rains in the northern
part of the watershed, where steep, bare rock slopes are common, leading to rapidly created
high-water levels, and eventually causing flooding of the cities original flood plain, that is now
urbanized. This includes embankment erosion near the Nuclear Plant that has been increasing.
The river basin where Metropolis is located is also slowly subsiding, which acts to amplify the
effects of sea level rise and storm surges. The other extremes experienced in recent years have
mainly occurred during La-Niña events, where precipitation has decreased accompanied by
drought conditions and heat waves, as wellas higher water temperatures about 5 ̊C warmer than
normal.

3.3. Climate projections in the Karibu River Watershed, based on
RCP4.5

Climate projections in the Karibu River Watershed, based on RCP4.5
Projections are to 2050 unless otherwise stated

Climate Variable

Probability of impact thresholds being exceeded

Temperature

Annual mean temperature rising by 2-3°C in the Upper Mountains and 1-3°C
in the river valley by the 2050s (compared to the 1970 to 2000 average).

By the 2080s annual mean temperature rising by at least 3°C in the Upper
Mountains and 2-4°C in the river valley

Increase in heat waves in summer and during La-Nina years with
o Very Likely occurrence of temperatures exceeding 35 ̊C in three

consecutive days.

o Likelyoccurrenceoftemperatureexceeding40 ̊Cononedayormore
leading to asphalt temperatures exceeding 64°C.

o Very Likely that the number of days >30°C will double by 2050, and
triple by 2080

• Warmer winters projected
o About as likely as not occurrence of extremely cold temperatures <-

20 ̊C.

Precipitation

Slight increase in mean annual precipitation by the 2050s (>5% compared to
the 1970 to 2000 average), and higher by the 2080 (>15%).

More intense precipitation in the late spring thru summer season and more
intense El-Nino related rains.

Overall slightly higher precipitation increase in the spring and summer than
the fall and winter.

Precipitation focused on shorter periods, with prolonged periods of drought.

Likely increase in thunderstorms with high intensity rainfall events in summer

(heavy rains over 70 mm/2-hr considered to be a 1-50 year event)

Very likely occurrence of freezing rain events, where ice accretion along the LRT
overhead catenary system and the Distribution lines/Utility polescould exceed

design standards of 12.5 mm.

Wind and storms

Likely Increase in extreme wind events with increased average and topwind
speed with sustained winds >90 km/hr and high wind gusts >120 km/hr.

Very Unlikely occurrence of F1 Tornadoes.

About as likely or not increase in the frequency and/or intensity of Typhoons.

Surface hydrology

More variable river flows likely.

Likely more frequent floods exceeding discharge of 4,300m3/s and exceeding

6.5m water level above sea level.

Longer periods without significant precipitation (dry spell).

Lower late summer river flows.

Very likely occurrence of variable water temperatures above 30 deg C. in the

Karibu River more than 5 days.

About as likely as not increase in the erosion of sloping land and reservoir

catchments.

Likely larger sediment loads occurring in the lower Karibu River.

Sea-level

Very likely sea-level increases of 30-50 cm by the year 2050, 50-70 cm by the
year 2080

Storm surges are likely to occur and are expected to have severe impacts
inland, depending upon elevation.

3.4. Climate projections in the Karibu River Watershed, based on
RCP8.5

Projections are to 2050 unless otherwise stated

Climate Variable

Probability of impact thresholds being exceeded

Temperature

Annual mean temperature rising by 3-4°C in the Upper Mountains and 2-4°C
in the river valley by the 2050s (compared to the 1970 to 2000 average);

By the 2080s annual mean temperature rising by at least 4-5°C in the Upper
Mountains and 4-6°C in the river valley

Increase in heat waves in summer and during La-Nina years with

o Virtually certain occurrence of temperatures exceeding 35 ̊C in three

consecutive days.
o Very likely occurrence of temperature exceeding 40 ̊C in one day or

more leading to asphalt temperatures exceeding 64°C.
o Virtually certain that the number of days >30°C will double by 2050,

and quadruple by 2080
• Warmer winters projected

o Unlikelyoccurrenceofextremelycoldtemperatures<-20 ̊C.

Precipitation

Slight increase in mean annual precipitation by the 2050s (15% compared to
the 1970 to 2000 average), and higher by the 2080 (>25%).

More intense precipitation in the late spring thru summer season and more
intense El-Nino related rains.

Overall higher precipitation increase in the spring and summer than the fall
and winter.

Precipitation occurring shorter periods, with prolonged periods of drought.

Virtually certain increase in thunderstorms with high intensity rainfall events

in summer (short and heavy rains with up to 60 mm/2 h).

Virtually certain increase in freezing rain events, where ice accretion along the

LRT overhead catenary system and the Distribution lines/Utility polescould
exceed design standards of 12.5 mm.

Wind and storms

Vitually certain increase in extreme wind events with increased average and
top wind speed with sustained winds >90 km/hr and high wind gusts >120
km/hr.

Unlikely occurrence of F1 Tornadoes.

Likely increase in the frequency and/or intensity of Typhoons.

Surface hydrology

More variable river flows very likely.

Very likely more frequent floods exceeding discharge of 4,500m3/s and

exceeding 6.5m water level above sea level.

Longer periods without significant precipitation (dry spell).

Lower late summer river flows.

Virtually certain occurrence of variable water temperatures above 30 deg C. in

the Karibu River.

Likely increase in the erosion of sloping land and reservoir catchments.

Very likely larger sediment loads occurring in the low Karibu River

Sea-level

Very likely sea-level increases of 40-70 cm by the year 2050, 80 cm – 1 m by the
year 2080

Storm surges are very likely to occur and are expected to have severe impacts
inland, depending upon elevation.

3.5. Climate projections in the Karibu River Watershed
(Pleasantville and Metropolis weather stations) for 2-hr
rainfall for 3 storm events, based on RCP4.5 and RCP8.5

Total
PPT

Pleasantville

T(years)

Historical

2030

2050

2080

GEV

RCP4.5

RCP8.5

RCP4.5

RCP8.5

RCP4.5

RCP8.5

25

56

58

59

61

62

62

66

50

66

67

68

70

73

71

76

100

76

77

78

79

82

81

88

Metropolis

T(years)

Historical

2030

2050

2080

GEV

RCP4.5

RCP8.5

RCP4.5

RCP8.5

RCP4.5

RCP8.5

25

54

55

56

59

60

60

63

50

61

63

64

66

69

67

71

100

68

69

70

71

74

72

79

3.6. Further uncertainty in projections for the 2-hr, 1-100 year
storm event in Pleasantville and Metropolis: low, 25%
quartile, median, 75% quartile, and high, for the RCP8.5

70.49

81.42

88.08

96.12

118.18

low

Q1

Median

Q3

high

67.11

73.13

79.23

89.3

113.56

low

Q1

Median

Q3

high

Appendix B: IPCC Likelihood Scale

Term

Likelihood of the Outcome

Virtually Certain

99-100% probability

Very Likely

90-100% probability

Likely

66-100% probability

About as likely as not

33 to 66% probability

Unlikely

0-33% probability

Very unlikely

0-10% probability

Exceptionally unlikely

0-1% probability

 
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challenging healthcare environments – My Blog

School of Nursing & Midwifery
Prof. Declan Patton
Leading and managing change
in challenging healthcare
environments
[email protected]
By the end of this class you will be able to;
1. Define managing change and leading change
2. Understand some specific skills for managing and leading change
3. Identify the steps of change
4. Identify principles of leading change management
5. Identify key elements of managing change in healthcare environments
Leading and managing change in challenging healthcare environments
Learning outcomes
School of Nursing & Midwifery
Prof. Declan Patton
Leading and managing change in challenging healthcare environments
What is managing change ?
School of Nursing & Midwifery
Prof. Declan Patton
There are a number of key features to managing change, these are:
1. Managing change is about having the ability to manage a complex situation and environment to bring about something
different
2. Managing change involves being able to assess, plan, implement and evaluate a situation in order to embed something
new into a practice system
3. Bringing about change is about developing something that is new and can sustain over time, it is not simply about
changing something in the here and now. This has previously been referred to as unfreezing old behaviours,
introducing new ones, and re-freezing them.
4. On the other hand, predictable change gives you time to prepare. However, in health care, change can often be
unpredictable and needs to happen fast, this is more difficult
5. The complexity of managing change is often represented in the juggle between managing people, technology and
systems
6. Even if change is endorsed, staff will want to understand why change is happening and how they will be affected. Clear
communication from the start is crucial

Leading and managing change in challenging healthcare environments
What is it like being the person leading the change?
School of Nursing & Midwifery
Prof. Declan Patton
1. Instigating change can be tiring as it involves you challenging the status quo and bringing others along with
you, providing that ground swell of positive motivation to make the change
2. The biggest challenge with this is convincing people that old habits can change, that there is a better way
of doing things
3. You will need time to bring about change and will have to be motivated and committed to do so, you will
also need to instill the motivation and commitment to change into others, this will all take time
4. In getting people onside, it is vital that you be clear about what is important and develop responses and
proactive actions accordingly, these responses and actions need to attract others to the change
5. It is also important that the vision you communicate to others is clear about what is now required, how
change will be measured and sustained over time and the benefits it will bring
6. You will also have to develop a change pathway that is attractive to people, for example, the change will
give them new experiences and meaning to what they currently do – you need to convince people that the
change is the right course to take
7. It is really important that the change is documented throughout so that future changes can be assisted by
what you did, and learn from what you did

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
However, there are barriers to change …
There are a number of barriers to change that you will need to build into your plan, all of these will need to be
addressed … Common barriers are …
Staff being unaware of the need to change as they do not fully understand up to date evidence, or staff may
know about new guidelines but do not understand that their practice has got to change
External motivating factors such as pay or incentives and internal motivating factors such as personnel drive
can effect ones motivation to change
Staff commitments and priorities may effect their willingness to change
Staff may find it difficult to change if an influential colleague disagrees with the change or the change is at
odds with other guidelines
Staff may be worried that they do not have the skills needed to make the new change a reality
Lack of resources, eg new equipment, may impede the change
Organisational regulation and finances may impede the change
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Handling, mediating and resolving conflicts
Coming up with solutions to problems
Handling, storing and retrieving information
Managing the career progression of people
Controlling the change environment
Assessing, planning, implementing and
evaluating actions
Specific skills you will need to lead and manage change
Good decision making
Appropriate planning
Able problem solving
Ethical soundness
Selling the change as something new and
beneficial
Managing skills Leading skills
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Steps of change model
(Kotter)
Create sense of urgency
Build the guiding team
Develop a change vision and strategy
Understanding and buy-in
Empower others
Short term wins
Be relentless
Create a new culture

Leading and managing change in challenging healthcare environments
Steps of change
School of Nursing & Midwifery
Prof. Declan Patton
Here is what Kotter’s sequential steps entail …..
Step 1: Create a Sense of Urgency: Help others see the need for change and the importance of generating new
ways of doing things
Step 2: Pull Together the Guiding Team: Make sure there is a powerful group guiding the change – a group with
leadership skills, credibility, communications ability, authority, analytical skills, and a sense of urgency
Step 3: Develop the Change Vision and Strategy: Clarify how the future will be different from the past, you need
to communicate that you have a firm understanding of this vision
Step 4: Communicate for Understanding and Buy-in: Make sure as many others as possible understand and
accept the vision and the strategy, this will depend on the effectiveness of how you communicate your change
message
Step 5: Empower Others to Act: Remove as many barriers as possible so that those who want to make the
change a reality can do so
Step 6: Produce Short-Term Wins: Create some visible successes as soon as possible
Step 7: Don’t Let Up : Pursue the change with even greater energy after initial successes
Step 8: Create a New Culture: Hold onto the new ways of behaving and make sure they succeed until they
become a part of everyday life

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
How can an organisation and its people be led through
the steps involved in the change process?
What leadership principles should drive the change
process?

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Ten Principles of Leading change management (Aguirre and Alpern
2014, model)

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 1 = Lead with the culture
There are 3 types of Organizational Leadership Cultures:
Dependent: leadership cultures operate with the belief that people in authority are responsible for
leadership
Independent: leadership cultures operate with the belief that leadership emerges out of individual
expertise
and heroic action
Interdependent: leadership cultures operate with the belief that leadership is a collective activity to
the benefit of the organization as a whole
Leadership culture is the way things are done; it’s the way people interact, make decisions, and
influence others. Its important that you lead by example fostering an interdependent culture

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 2 = Start at the top
Although it’s important to engage employees at every level early on, all successful change
management initiatives start at the top, with a committed and well-aligned group of executives
strongly supported by the CEO
Work must be done in advance to ensure that everyone agrees about the case for the change and
what is needed for implementing it

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 3 = Involve every layer
Change efforts must include plans for identifying leaders throughout the company and pushing
responsibility for design and implementation downwards, so that change “cascades” through
the organization.
At each layer of the organization, the leaders who are identified and trained must be aligned to
the new vision and motivated to make change happen

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 4 = Make the rationale and emotional case
together
1. Articulate a convincing need for change
2. Provide a clear road map to guide behaviour and decision making
Leaders must customize the change message for different audiences, for example, managers and
employees

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 5 = Act your way into new thinking
• Make major, visible decisions with targets set out in days instead of weeks or months
• Spend time with all staff on the frontline, asking for their input and engaging them in
discussions about the change

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 6 = Engage, engage, engage
Sustained change requires constant communication, not only throughout the rollout but after
the major elements of the plan are in place
Use different types of communication, this will make your messaging more effective
In your communications, keep the change to the forefront as well as how close targets are to
being achieved

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 7 = Lead outside the lines
Change has the best chance of cascading through an organization when everyone with authority and
influence is involved. In addition to those who hold formal positions of power, this also includes other
recognized leaders such as people whose power is more informal and is related to their expertise, to the
breadth of their network, or to personal qualities that engender trust
There are three types of informal leaders:
• Pride builders are great at motivating and inspiring others to take pride in their work
• Trusted nodes are go-to people. They are the ones approached by people who want to know what’s really
happening in the organization
• Change or culture ambassadors know how to live the change the organization is making. They serve as
both exemplars and communicators, spreading the word about why change is important.

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 8 = Leverage formal solutions
Persuading people to change their behaviour won’t suffice for transformation unless formal elements
such as structure, reward systems, ways of operating, training, and development are redesigned to
support them. If organisation systems, training, processes and tools don’t support the change that is
being rolled out then it has less chance of succeeding and becoming the norm

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 9 = Leverage informal solutions
A change that fundamentally affects culture requires some extra attention. Staff
need to be engaged from an early stage working interdependently to effect and
maintain a culture shift that will help bring about the desired change

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Principle 10 = Assess and Adapt
Measure the success of the change and adjust and adapt it based on the
current level of adoption
This involves establishing some key outcome metrics that indicate the success
of the change
Once the metrics are established, they must be measured and monitored over
time, with possible tweaks being made to improve the move towards the
change

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Managing change in healthcare environment
Here are some key reminders …
Effective change has been characterized as unfreezing old behaviours, introducing new ones,
and re-freezing them
Predictable change allows time for preparation, whereas unpredictable change is more difficult to
respond to effectively
Since changes in healthcare occur so rapidly, they are less likely to be predictable
Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Managing change in healthcare environment
Bringing about change requires the leader to challenge the status quo, and requires
perseverance against the habits and norms of established behaviours
Bringing about change takes time and requires the commitment of time on the part of the
leader
The leader must know the values that matter and focus on changing those as opposed to
reacting to every invitation for change
The leader must be clear about what is important and develop responses and proactive actions
accordingly

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Managing change in healthcare environment
Change is not about telling staff what to do … Leaders have to learn how to
manage change
Leaders should help staff structure and build effective teams by developing new
organizational structures and creating a shared vision that staff understand and
have contributed towards

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
Managing change in healthcare environment
Establishing a clear vision about the direction of the change process is a key element for assuring
successful change
Measuring and monitoring outcomes of the change process is essential for recognizing whether or not
the change process has fulfilled its purposes
Since change is continuing to happen in organizations and associated modifications are taking place,
it is important for those who are in charge of the change process to record and focus on the emerging
problems due to change

Leading and managing change in challenging healthcare environments
School of Nursing & Midwifery
Prof. Declan Patton
References and further reading
www.hse.ie/changeguide
Al-Abri, R (2007) Managing change in healthcare. Oman Medical Journal. 22(3). P9-10
https://www.nice.org.uk/guidance/lifestyle-and-wellbeing/behaviour-change
https://www.nice.org.uk/media/default/about/what-we-do/into-practice/support-for-serviceimprovement-and-audit/how-to-change-practice-barriers-to-change.pdf
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-4999-8
https://www.bmj.com/content/361/bmj.k2014
http://www.ihi.org/resources/Pages/Changes/default.aspx
Aguirre DA and Alpern M . 10 principles of leading change management. Organization& People 2014, Issue 75
Kotter, J. Leading Change. Harvard Business School Press, Boston, MA, 1996

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