both incurable and highly communicable diseases among this population, and an evolving social milieu that to some people causes the unthinkable to be considered creates moral, ethical, and practical dilemmas for many in the nursing profession. This situation provides justification for this investigation.
Changing Conditions in Health Care That Can Affect Nursing Attitudes Toward Patients
The incidence of tuberculosis in the United States over the past 15 years has increased dramatically (Eubanks, 1992, p. 60). During this period, tuberculosis has become increasingly drug resistant causing treatment to be less effective and control to become more difficult (Gebhart, 1992, pp. 37 41). Tuberculosis is most prevalent in the nation's inner cities (Kindel, 1993, p. 48). The increase in immigration from developing areas of the world over the past 15 years has contributed to the problem, as a significant proportion of these individuals arrive in the United States already suffering from serious illnesses such as AIDS (acquired immunity deficiency syndrome) and tuberculosis. AIDS and tuberculosis are frequently found in the same patient. Tuberculosis is an infectious disease. Once tuberculosis patients have taken their medication "regularly for a few weeks," however, "they lose their capacity to infect others if the TB strain is sensitive to these drugs. At that point, they can return to work and lead relatively normal lives provided that they continue to take the drugs that will eventually wipe out all the bacteria they carry" (Conspicuous consumption, 1993, p. 8). Failure to comply with treatment regimens cause patients to relapse and frequently permit "drug resistant strains of bacteria" to "flourish in their bodies" (Conspicuous consumption, 1993, p. 8). Patient non compliance is a major problem in the control of tuberculosis.
Following a steady and relatively rapid decline in the number of new cases of tuberculosis repor...