Interprofessional collaboration is “the process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients/clients/families, and communities to enable optimal health outcomes [10] ”. Elements of collaboration include respect, trust, shared decision making, and partnership. There are four competencies that comprise interprofessional collaborative practice: “1) Values/Ethics for Interprofessional Practice: work with individuals of other professions to maintain a climate of mutual respect and shared values; 2) Roles/Responsibilities: use knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of the patients and populations served; 3) Interprofessional Communication: communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease; 4) Teams and Teamwork: apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient-centered care that is safe, timely, efficient, effective, and equitable [11] ”.

Riley et al. (2013) stated that “What has been learned in the research setting is often not implemented into daily practice. A major challenge for practitioners is that most evidence-based interventions are not ready for widespread dissemination [12] ”. It may take as long as one or two decades for original research to be put into routine clinical practice. Many reasons have been offered for this slow and incomplete translation, such as research methods being complicated, and reporting standards that are not relevant to the clinical settings [13]. The appearance care program developed and evaluated by our intervention study, which was conducted for one and a half years, was chosen to be implemented into daily clinical practice when the research was terminated. The aims of this study are to describe and discuss the process of changes in the organization through research activities to understand how new interventions in research settings can become integrated into daily practice, from the perspective of nurses’ proactive engagement.

This study was conducted in one hospital (hereafter as hospital A), which holds 520 beds and provides advanced medical treatment for outpatients and inpatients. The hospital was accredited by the Joint Commission International in 2012, and accreditation has been renewed ever since then. The development and implementation took place in the breast center and oncology center.

To respond to the needs of breast cancer patient who were suffering from appearance-related distress, we created a team of oncology nurses, clinical psychologists, and licensed beauticians to develop an intervention program that addressed patients’ health care needs along with their aesthetic care needs. The program was developed through a literature review and discussions through interprofessional collaborative practice. Through this process, the appearance care program was developed and pilot tests confirmed that the objectives of the program were met. The nurses used their knowledge of appearance-related side effects, combined with coping skills provided by the beauticians, and the principles of makeup to help maintain healthy looks during treatment.

To describe the process of translating the research into practice, we conducted an exploratory case study. We approached key informants, that is, nurses who had been involved in most of the total process starting from the planning of the research design, due to the exploratory characteristic of the study. A number of patients who participated in the intervention program were 72 in total. They were also our informants, although we considered nurses as our primary participants for this study. Three nurses were interviewed who were involved from the planning of the research design. One was an assistant manager of the oncology center, one was a research nurse, and the other was an accredited certified nurse specialist in cancer care.

Mari Ikela was the primary investigator (PI) of the intervention evaluation research. PI conducted face-to-face semi-structured interviews. The interview guide included four sections: patients’ needs regarding appearance-related care and by whom should it be done if necessary; the effect of participating in the study; the effect of working together with non-medical professionals such as beauticians for patient care; and the effect of interacting with patients outside the outpatient clinic and what they learned from patient feedback. The interviews lasted approximately one hour for all participants and were audio recorded with participants’ consent. Interview was conducted in a private room after nurses have finished their shifts. Interviews were transcribed verbatim. We also supplemented the data with conference minutes and verbatim transcripts of the expert panel meeting.

“Each transcribed interview was initially read thoroughly and notes were taken to bring out the character of the text”, in accordance with the thematic content analysis procedure [14]. We used the competencies of interprofessional collaborative practice for the analysis. All significant content was extracted from the data. To secure the validity of the analysis, the co-authors were involved throughout the entire process to achieve consensus at the word, sentence, and discourse levels.

The study protocol was reviewed and approved by the IRB of the author’s institution. The approval was received in accordance with the ethical statements provided by IRB in accordance with the Declaration of Helsinki.

The appearance care program (here after referred as ACP) consisted of a group intervention facilitated by the nurse, aiming to build values and apply the principles of team dynamics to collaborate effectively and provide patient-centered care that is safe, timely, and effective. In studies reported elsewhere, we have designed and initiated the ACP and evaluated it carefully. After completion of the research with a positive outcome, the clinical setting chose to continue the program as an aspect of daily clinical practice.

Figure 1 presents the flow of stages to “Translating Research into Practice.”

Before forming the expert panel, we conducted a literature review on appearance care for patients undergoing chemotherapy. Theories of learning and coping were reviewed to decide upon the model of care intervention.

Since the late 1990s, chemotherapeutic regimens based on anthracyclines and taxanes have been introduced. This therapy causes complete alopecia in most patients. Many women consider alopecia to be one of the most painful and scared side effects of chemotherapy. Nurses looking for ideas to ease patients’ pain attended classes to learn how to hide chemotherapy changes with make-up, which was called a “rehabilitation make-over.” However, this was difficult to implement in daily care. The nurses were interested in what volunteers were providing but had never shared their thoughts. The research introduction was a turning point for both nurses and volunteers/survivors. It is rare for interprofessionals such as nurses, doctors, beauticians, and survivors to form a team together and develop an intervention program. The current research proposal was a good match for the nurses’ goals, and the content of the intervention was discussed between different professionals, leading to increased competency.

When women learn that they would lose their hair during chemotherapy, they start anticipating the impact of hair loss on themselves and people around them. Anticipation of an undesired event can cause anxiety, fear, or even depression. This is more so if women feel there are no other options resolve this issue. Anticipatory coping is the process of anticipation with preparation for an event. By taking specific actions to determine how they will look without hair, how they would manage their appearance in social environment, women gain a greater sense of control over their changing appearance. Borsellino et al. (2011) reported, “This greater sense of control may ease or lessen feelings of fear and depression and help women to take control of other aspects of their lives that contribute to a greater quality of life during cancer treatment [15] ”. The core concept of the program thus focused on proactive coping skills [16] and integrated the anticipatory coping skills to promoting peer support through the process of self-reflection. It is important to provide timely and accurate information about the side effects of treatment and the potential for anticipatory coping strategies to reduce distress [17]. Group intervention provides women with the opportunity to learn with other women in a similar situation. “This may help to alleviate the sense of loneliness and provide additional social support [18] ”.

Borsellino et al. (2011) discussed that, “Oncology nurses are in a unique position to help women turn their anxiety about hair loss into an anticipatory coping process, one that increases women’s sense of control over some of the outward changes taking place in their bodies [15] ”. This may lead women to be more proactive toward the treatment of cancer.

The research team set regular meetings at the beginning of the new cycle of sessions. The meetings were purposefully planned; otherwise there would be no chance to exchange information. These interactions were done to confirm the goals and vision of the ACP. Thus, practical knowledge was accumulated through interprofessional discussions.

The nurse manager had control over staff shifts, so three other nurses were able to join as providers of the program. The nurse manager utilized her position of power to expand the providing team. The interaction between nurses and beauticians created wider perspectives on the possibilities for providing care to patients. The session led by a nurse contained information introduced at the time of orientation to chemotherapy, although orientation was mainly done orally and while the patients were in a stage of denial, a common defense mechanism. By developing the ACP, awareness was built while interacting with peers on the same path. The process of anticipation became visual and was explained interactively in the program.

A limitation of this study is that the study is one case study with the hospital A and for the feasibility, other observation and requirements may have to be considered.