Gwybod and Nabod. To Know and TO KNOW.

I have developed lots of lovely and intellectually productive work relationships as a consequence of my external engagement role in Cardiff Business School.  One of which is with Diana Reynolds from the Sustainable Futures Division of Welsh Government.  Diana is one of the most passionate people I know about the importance of learning and about the importance of the right environment for human beings to thrive and grow.  She teaches me curiosity and thoughtfulness and I’m grateful to know her.

In one of our recent meetings I told her about some of my frustrations with my Dad’s recent experience in a hospital. He’s been very unwell unfortunately, but is now, hopefully, on the mend.  He contracted a nasty chest infection alongside all of the other medical issues that he was dealing with and one evening, when we were visiting, he was really struggling for breath.  He was noticeably uncomfortable, breathing extremely rapidly and it was exceptionally painful to watch.  My lovely Dad lying there, desperate for air, and me, powerless to do anything about it.

Such was the critical nature of his illness, he was hooked up to multiple monitors and devices, all doing their job of informing those around him of his status, bleeping intermittently to alert people of the need for some form of intervention.

I watched his oxygen saturation number glowing yellow.  (I am now good at reading these monitors fyi they obsessed my thoughts over the first 2 weeks of his care) 89% oxygen saturation. It had been 98-96-94 previously.  A global covid 19 pandemic had also made me become intimately acquainted with an Amazon acquired pulse oximeter and I knew what levels constitute ‘good’ and what are ‘not so good’.

I asked the nurse whether she could give him some oxygen to help him.  He was, surrounded by at least 2 different oxygen options such was the nature of his critical care.

“I can’t give him any at the moment.  The Doctor has assigned his tolerance level as between 92 – 88”.  Perplexed, I, imagine sharply, retorted “Let’s wait until it gets to 87% and then give to him shall we?”!

Dear reader, his levels did of course then reach 88.. 87.. 86… and then Oxygen was duly administered which instantly helped his O2 level to increase.

You know that I love common sense and practical, employee empowered, approaches to problems and I just couldn’t quite believe that that nurse didn’t help my Dad when, from what I could see at least, he quite obviously needed it.

I relayed my frustrations to Diana and we discussed how litigious healthcare is, and that there had probably been many different interventions designed to establish protocols, and staff adherence to protocols, specifically to protect patients. We discussed how difficult such environments are to get the balance right between patient centricity and process compliance.  Diana then went on to explain:

“You see there are two types of knowing.  There’s the regurgitating information knowing, and the knowing where you truly recognise, connect and understand. Welsh has two different words for the two different types – Gwybod and Nabod. Gwybod is to know a fact and Nabod is to truly KNOW a person or a place.  There is recognition and emotion that comes alongside that knowledge of that person and place. They are different things”.

(Interestingly, this is the SECOND blog I’ve written about the power of the Welsh language! The first was about the power of combining ‘to learn’ and ‘to teach’ in the same word – “Dysgu”. John Parry-Jones will be proud of me).

The nurse that day was applying Gwybod.  Looking at the patient file and what was an acceptable oxygen level before intervention was required, looking at his monitor to tell her what the oxygen saturation level was and whether it was within this tolerance. She was not employing Nabod.  To know the person. To use her eyes and intuition about the patient in front of her, listen to the family members that knew him, and act on instinct, emotion and connection as to what was required.

You could argue of what difference the hour without the oxygen actually made …. probably absolutely nothing in the scheme of things …. but what mattered to me was the doubt laid in my mind as to whether people were able to make healthcare decisions that were in the genuine interest of my Dad. Could care only be provided if it had been written down (illegibly) in a file by someone else “more qualified”?  We had another incident where he had a headache and no one was able to give him paracetamol because someone had inexplicably crossed paracetamol off his drug chart.

Donald T. would probably be pleased.

So yes, how to get the balance right between Gwybod and Nabod? My Aunt, Dad’s sister, was a senior nurse all her life, trained in the old school nursing tradition of capes with crossbody ribbons and upside-down nurses watches, said that one of the most powerful things that she had seen in her career was when a Ward Sister had insisted that above each patient’s bed, should be a recent photograph of that person, happy and well, to remind everyone who they were caring for, of who they were trying to return back to their loved ones.  A Nabod connection device.

Delicately navigating the difference between Gwybod and Nabod should be something that we think about deeply within our design of our public services.

We need services to be both full of expertise AND empathy.  Both should have equal power and weight.

Diana is responsible for the great Building culture for co-production [HTML] | GOV.WALES manual to help organisations apply the Future Generations Act – have a look at all of the great thoughts within!