Tran, Stone, Fernandez, Griffiths, and Johnson (2009) examined the effectiveness
of implementation of clinical practice guidelines on nurses screening patients for alcohol
abuse. While this was not a study related to early mobility, it does discuss the factors
related to changing practice through use of a protocol and guidelines. Factors were
identified that limited the effectiveness of the clinical practice guideline, including design
of the education program, existing level of knowledge and competence, and strategies in
place to ensure sustainability of the program. The authors suggested that the readiness of
the nurses to adopt guidelines into practice prior to implementation of the guideline was a
critical factor in the subsequent change in practice. Sustainability of a policy
implementation may require considerable structured processes for it to become integrated
into normal practice (Tran et al. (2009). This study highlighted the difficulties of
introducing and sustaining change amongst health professionals.