A 95-year-old female hospice patient with a hip fracture refuses hospital transport. What is the best course of action?

• A. assist her back into bed.
• B. encourage her to go to the hospital.
• C. apply a traction splint and contact medical command.
• D. immobilize her to a long backboard and transport her.

Answer: (B)

The main idea is respecting a competent patient’s right to make decisions about their own care while ensuring they understand the risks and benefits of treatment options. In this scenario, the patient is elderly, in hospice, and has a hip fracture—conditions that require medical assessment and pain control. Even though she may prefer to stay home, the best course is to gently encourage hospital evaluation so she can receive appropriate pain management, confirm the extent of the injury, and address potential complications. Provide clear information about what staying home could mean (increased pain, risk of delirium, dehydration, immobility-related complications) and assess her decision-making capacity. If she remains capable and still refuses, that decision should be respected, and comfort measures with documentation should follow.

Why the other options aren’t appropriate: returning her to bed ignores the risk of untreated fracture and potential complications; performing a traction splint and contacting medical command is not indicated for a hip fracture in this context and could be harmful or coercive; immobilizing and transporting against her wishes would override her autonomy and is not appropriate when she can make an informed decision.