Comfort care

On my neuro placement, i treated a 92 y.o. male with parietal subdural hematoma as a result of a fall. Prior to the fall he is independent with all ADLs and ambulates with a walking stick. When i first see him, he appears confused and weak in his lower and upper extremities. He couldn't communicate well with everyone and has developed dysphagia. He also has anosognosia. I worked on his sitting balance all week and did not achieve much. It was also hard for nurses to transfer him with the pulpit frame due to his weak legs and trunk muscles. He is not taking in adequate food or fluid. The doctors and the family agreed to provide him with 'comfort care' instead of active treatment which will include tube feeding. I wasn't too sure what 'comfort care' means in terms of physiotherapy. My supervisor then asked the doctors if they are happy for physiotherapy to continue just to make transfers easier on the nurses. They were happy for that and so i continued treating that patient just to improve his sitting balance and ability to sit to stand to make transfers easier. However, one evening, when the patient was placed on a high back chair, the patient was seen kneeling on the floor trying to get back on to the bed. I felt responsible for the event as I was the one who encouraged the nurses to sit the patient out on the chair for as long as he could tolerate. It didn't occur to me that the patient also has lack of insight of what he is able to do and what he needs to do to get back into bed (i.e. call the nurses to assist). Since then I have decided that he could only sit on a recliner chair and that there is not much purpose in keep working on his sitting balance when sitting and transferring him via pulpit frame will be unsafe for him and the nurses. He is also seen on a few occassions trying to climb out of his bed trying to go to the toilet, and he has rails put up on the sides of his bed since. The nurses have been transferring him with the hoist after the incident and is now waiting for a HLC nursing home.
I realised that when treating a patient, we have to be realistic on what a patient is capable of and progressing a patient who is cognitively impaired is sometimes inappropriate.