Högskolan i Skövde

The CRISPR-Cas9 system represents a transformative therapeutic platform for monogenic blood disorders such as sickle cell disease (SCD) and β-thalassemia. However, clinical translation is limited by safety concerns related to unintended off-target genomic alterations. This systematic review and meta-analysis quantified the prevalence and evaluated the severity of CRISPR-Cas9 off-target effects in hematopoietic models of blood-related genetic diseases. Seventy-eight studies were included in qualitative synthesis, and five comparative studies were analysed using a random-effects meta-analysis. High-fidelity Cas9 variants significantly reduced off-target risk compared with wild-type SpCas9 (pooled OR = 0.15, 95% CI: 0.08–0.29), corresponding to an 85% reduction in off-target odds. Substantial heterogeneity was observed (I² = 76.3%), primarily attributable to differences in off-target detection methods, as variations in methodological sensitivity can systematically influence the number and frequency of detected off-target events, contributing substantially to the observed heterogeneity. Subgroup analyses showed greater specificity improvements when assessed using unbiased genome-wide methods (OR = 0.08) compared with targeted sequencing (OR = 0.23). Although high-fidelity variants markedly improve safety profiles, methodological variability and limited long-term in vivo data remain important considerations. These findings provide quantitative evidence supporting the potential use of high-fidelity nucleases and comprehensive genome-wide assessment to enhance the safety of CRISPR-based therapies for hemoglobinopathies.

Background: Caring for children in emergency settings places significant demands on nurses’ clinical and theoretical competence, communication skills, and ethical judgment. Children differ from adults in physiological, psychological, and developmental aspects, requiring that nursing care, assessment, and interactions be grounded in specialized knowledge and experience. To generate knowledge that can enhance support and education for nurses, as well as improve the safety and quality of pediatric care, it is essential to examine nurses’ experiences of caring for children in emergency settings.

Aim: The aim of the study was to describe nurses’ experiences of caring for children in emergency care settings.

Method: A literature review with an inductive scientific approach was chosen as the method for this study. Ten scientific articles were selected for analysis. Seven of the articles were qualitative, one was quantitative, and one had a mixed-methods design.

Results: Nurses lack experience and knowledge when caring for children in emergency settings, which leads to uncertainty, whereas increased experience contributes to greater self-confidence. The findings indicate a need for enhanced organizational support following traumatic events involving children. Guardians can provide nurses with important information about the child’s condition. Caring for children in emergency care may evoke strong emotional responses in nurses and personal distress, particularly in situations involving resuscitation or the death of a child.

Conclusion: Caring for children in emergency settings is both complex and emotionally demanding. Organizational support and effective collaboration with parents or guardians are essential for ensuring high-quality care and promoting nurses’ well-being.

Background: Acute lymphoblastic leukemia (ALL) in children is a serious blood cancer that requires long-term treatment. The disease involves repeated hospitalizations and affects the entire family’s life situation and psychological well-being. Parents of children with ALL can be affected in different ways by the changed life situation that occurs in connection with the disease. There is therefore a need for increased understanding of parents’ experiences of having a child diagnosed with ALL. Family-centered care involves including the family to promote participation and is grounded in the child’s best interests, with the nurses working from an ethical and person-centered approach.

Aim: The aim of the study was to illuminate parents’ experiences of living with a child diagnosed with Acute Lymphoblastic Leukemia.

Method: The study was conducted as an integrative review of qualitative research. There were ten scientific articles that were included in the study results.

Findings: Three themes were identified in the results: From shock to coping- emotionally overwhelming; increased responsibility and changed family roles; and the need to adapt to a changed life situation.

Conclusions: The study shows that parents of children with ALL often experience emotional stress and practical adjustments. At the same time, parents develop strategies to handle the situation and regain everyday life. The nurse has a central role in supporting the family, alleviating suffering and promoting participation through family-centered care.

This paper examines family firms that have endured for more than 100 years, focusing on how their hybrid identities, combining the normative values of the family with the utilitarian goals of the business, contribute to their longevity. We address two research questions: How do family firms achieve longevity beyond 100 years? How do long-lived family firms develop into hybrid identity organizations? Empirically, we study long-lived family firms in Germany and Sweden, drawing on insights from the hybrid identity literature. We identify three key referents, historical, family, and industry-specific, that shape the development of hybrid identities over time. We argue that these referents play a central role in sustaining longevity, as they enable firms to evolve into hybrid identity organizations.

Background: The disease often follows a relapsing-remitting course with recurrent exacerbations. During these periods, inflammatory activity increases, leading to worsening symptoms and a greater need for healthcare. In Sweden, approximately 20,000–30,000 individuals are affected by Crohn’s disease (CD), corresponding to about 0.2–0.3% of the population, and the disease affects men and women equally. The causes of disease onset include genetic factors, lifestyle, and diet. Aim: To explore patients’ experiences of living with Crohn’s disease. Method: This study was conducted as an integrative review of qualitative research inspired by meta-synthesis. This approach involves summarizing the current state of knowledge within a specific area. Results: The results are divided into three themes: communication is important and relationships are affected; time spent outside the home is complicated; and practical challenges in Crohn’s disease. The findings show that Crohn’s disease significantly impacts patients’ daily lives, mental health, and social functioning. To manage the disease, patients adapt their lifestyles and develop various coping strategies, with differing experiences of healthcare. Conclusion: This literature review demonstrates that living with CD entails a substantial impact on patients’ daily lives, relationships, and psychological well-being. The unpredictability of the disease, the complexity of symptoms, and the psychosocial burden contribute to limitations in social life, work, intimacy, and physical activity.

The applied austempering heat treatment to an as-cast ferritic CGI alloy resulted in a significant increase in hardness and micro-scratch resistance of the heat-treated samples compared to the as-cast sample. In the present study, the samples were extracted from as-cast pieces and heat treated by austempering under austenitizing temperature of 900 oC for 60 minutes, which followed by quenching in salt-bath at 325oc for various austempering holding time 30, 60, 90 and 120 minutes. The effect of austempering time was investigated on the final microstructure, hardness, and micro-scratch properties of the achieved samples. Light optical and scanning electron microscopic together with EBSD analysis of the samples showed the ausferritic matrix formed in all heat-treated samples without affecting the graphite forms. The Brinell hardness measurements of the ausferrite matrix showed a significant increase in hardness compared to the ferritic CGI, however, the maximum increase was observed for the shortest austempering time. In addition, nano-hardness values showed a quite significant variation in the matrix due to the presence of acicular ferrite and carbon-saturated retained austenite. Increase of austempering time led to decrease of carbon saturated retained austenite. However, for austempered samples above 60 minutes austempering time, the scratch hardness showed an increase trend with austempering time, a constant value was observed for the ferritic CGI alloy.

Background: All healthcare personnel have a central responsibility to follow basic hygiene routines, which are important for preventing the spread of microorganisms, viruses, and bacteria that can contribute to healthcare-associated infections. Healthcare-associated infections can lead to longer hospital stays, patient suffering, and high costs for society. Aim: The aim of this study was to highlight the factors that influence nurses' adherence to basic hygiene routines. Method: The study was conducted as a general literature review that included qualitative, quantitative, and mixed-method studies. A total of 12 articles were included in the study. Findings: The results have been identified in four areas: gaps in knowledge and information, individual and social factors, promoting factors, and organizational factors. These areas highlight factors that influence nurses' compliance with basic hygiene routines. Conclusion Healthcare-associated infections can be avoided by healthcare personnel implementing correct basic hygiene routines. Furthermore, there is a need for continued research to identify educational and organizational measures that can improve compliance in clinical practice.

En central mekanik inom rytmspel är synkroniseringen mellan musik och gameplay. Denna litteraturöversikt undersöker vilka metoder det är som används för att synkronisera musik med gameplay i rytmspel, samt vilka för- och nackdelar dessa metoder har. Denna studie genomfördes som en systematiserad litteraturöversikt, där både vetenskapliga och industriella källor inkluderades i analysen. Resultatet från den analys visar att det finns två metoder som framträder i litteraturen, nämligen conductor-baserad synkronisering och MIDI-baserad synkronisering. Conductor-baserad synkronisering bygger på musikens BPM, medan MIDI-baserad synkronisering bygger på datan från en MIDI-fil. Metoderna har olika fördelar och nackdelar, och valet mellan dem beror på vilka krav och förutsättningar som rytmspelet har.

Background: Mental illness constitutes a growing public health issue and may lead to significant suffering for individuals. Within somatic care, specific challenges have been identified, where patients with mental illness report inadequate care encounters, communication difficulties, and experiences of stigmatisation. These factors may negatively affect the nurse–patient relationship, highlighting the central role of nurses in providing person-centred care and promoting good mental health. Aim: To explore nurses’ experiences of caring for patients with mental illness within somatic care. Method: The study was conducted as a literature review with both qualitative and quantitative approaches. A total of eleven scientific articles were included, identified through relevant databases, and analysed in accordance with Friberg’s analysis model. Results: The analysis resulted in two main themes; Professional competence and support structures in nursing care and Emotional and psychological dimensions of care encounters. The findings showed that nurses experienced a lack of knowledge and insufficient organisational support as barriers to caring for patients with mental illness. Care encounters were often characterised by uncertainty, fear, and emotional strain, while also reflecting empathy and a willingness to provide good and person-centred care. Conclusion: The literature review demonstrated that nurses face challenges when caring for patients with mental illness in somatic healthcare. A lack of knowledge contributes to uncertainty among nurses, and patients’ needs risk being overlooked. Collegial support was identified as an important resource for strengthening confidence and promoting reflective practice. The need for increased knowledge to counteract stigmatisation was highlighted as essential for achieving person-centred care.

This article advances a discourse-theoretical reconceptualization of societal grand challenges. In organization studies, grand challenges have become a privileged vocabulary for engaging urgent societal problems such as climate change, global health, and sustainable development. While this expanding literature has generated insights into how such problems may be addressed, less attention has been paid to the processes through which grand challenges are constructed, framed, and legitimized as shared objects of concern. Drawing on Laclau and Mouffe’s discourse theory, I argue that grand challenges derive their organizing force from their operation as empty signifiers, discursively open terms whose indeterminacy enables them to gather heterogeneous meanings and defer closure. As empty signifiers, they evoke a shared social imaginary that organizes collective action in response to what is perceived as absent or lacking in society. In this view, the articulation of a grand challenge is a political project in which hegemonic ordering takes place, selectively privileging certain interpretations and shaping legitimate action against a backdrop of apparent consensus. To theorize how grand challenges acquire meaning, I develop a triadic model of signification that conceptualizes them as empty, floating, and partially fixed signifiers. The article’s primary contribution is to reconceptualize grand challenges as hegemonic projects constituted through articulatory practices. The discussion derives three analytical implications for grand challenges scholarship: (1) approaching problem articulation as a political process, (2) reorienting empirical inquiry toward tracing situated partial fixations, and (3) making explicit the epistemic assumptions underwriting solution-oriented research.

Self-touch and interpersonal touch feel very different—self-touch sensations are attenuated. The distinction between self- and not-self not only influences properties such as intensity, but also qualitative aspects of touch. This is highlighted by the social softness illusion, wherein another person’s skin is perceived as softer and smoother than the own skin. The mechanisms underlying these qualitative differences of self- vs social touch remain unclear. Across four experiments, we explored such qualitative aspects of touch sensation in eighty-two healthy females. We investigated both the social softness illusion and self-touch across multiple body parts. We found that the social softness illusion only occurs under a specific condition: when the palm was touching the forearm. When the forearm instead touched the palm, a self-softness illusion emerged. For self-touch, we found differences between forearm touching palm and palm touching forearm, which were not directly linked to the movements of the palm or forearm. We also found an interaction between movement and velocity for pleasantness, where velocity mattered more during external than self-generated movements. Agency too influenced the qualitative aspects, particularly interacting with the velocity. We corroborate earlier studies showing a preference towards social touch for social interactions and the suggested soothing mechanism of self-touch. The hedonic benefits of self and social touch emerge for different reasons, therefore comparing these competing systems is complex. When comparing the qualitative aspects of social and self-touch, one must consider these two complimentary functions, with potentially different underlying psychological and neurophysiological substrates.

Background: When a child is diagnosed with leukemia, the entire family’s world changes. The everyday life that was once taken for granted is replaced by hospital stays, medical treatments, and constant concern about the child’s future. To support parents in this situation, nurses need a deeper understanding of their feelings in order to provide the best possible support in managing their new everyday life.

Aim: To study mothers´ experienced feelings of living with a child who has leukemia.

Method: The data consisted of twelve public Instagram accounts written by mothers of children with leukemia. The study used a qualitative content analysis in which the manifest content was analyzed.

Findings: The results showed three categories: disturbed feelings of safety and mental well-being, a draining existence marked by guilt, grief, and hopelessness, and maintaining hope and inner strength in a vulnerable everyday life. These categories included ten subcategories, such as shock, uncertainty, guilt, and powerlessness. At the same time, moments of hope, strength, and meaning appeared, helping them cope with their changed situation.

Conclusion: Being a mother of a child with leukemia is a challenging experience that involves suffering and deeply affects everyday life. To provide person- and family-centered care, nurses need a better understanding of mothers’ emotional experiences.

Background: Nurses’ encounter patients who are exposed to domestic violence in their work. Despite this individuals subjected to such violence perceive that healthcare services are deficient in their treatment and in the ability to identify exposure to violence.

Aim: To describe nurses’ experiences of encountering patients who are exposed to domestic violence.

Method: A general literature review based on both quantitative and qualitative studies.

Findings: Nurses’ call for increased education and stronger organizational support in their work with patients exposed to violence. Despite a clear commitment, they report an insufficient level of knowledge in this area. Furthermore, the need for clearer guidelines for care of patients exposed to violence is emphasized. Nurses’ also highlight the importance of collegial support, as working with this patient group can entail a significant emotional burden.

Conclusion: The study’s result show that nurses’ experience significant barriers when encountering patients exposed to intimate partner violence, including lack of knowledge, unclear guidelines and emotional strain. These experiences highlight the need for clearer guidelines, increased organizational support and expanded education to strengthen nursing care. Nurses’ play a central role in identifying patients subjected to violence, which presupposes adequate competence and a responsive, empathetic approach. If these patients are not identified, they risk remaining in a situation characterized by continued suffering.

Background: Social media is a significant part of daily life and serves as a source of health information. Both evidence-based knowledge and misinformation about vaccinations are present, potentially influencing guardians’ perceptions and decisions regarding childhood vaccination.

Purpose: The aim of the study was to examine how social media affected guardians’ attitudes towards vaccination.

Method: The study was conducted as a quantitative survey with qualitative elements. Data were collected through an online questionnaire distributed via social media. The sample consisted of guardians of children aged 0-15 years, with a total of 95 participants. Data were analyzed using descriptive and inferential statistics, along with qualitative content analysis of open-ended responses.

Results: Most participants did not perceive social media as influencing their attitudes toward vaccinating their children. However, exposure to misinformation was associated with increased vaccine hesitancy, particularly regarding newer vaccines. Among guardians who chose not to vaccinate, reasons included lack of knowledge and fear. The results also showed that clear and reliable information from healthcare services increased willingness to vaccinate.

Conclusion: Social media may exert an unconscious influence on guardians’ attitudes toward vaccination. While participants reported exposure to misinformation, positive information also supported vaccination decisions. Providing evidence-based information and addressing guardians’ concerns and informational needs is essential for a preventive approach to improving public health.

Background: Breast cancer is the most common form of cancer affecting women worldwide. The disease entails not only physical problems but also psychological distress, which can lead to feelings of hopelessness, suffering, and emotional and existential impact. Nurses play a central role in alleviating suffering, promoting health, and providing support. Purpose: The purpose is to shed light on women’s experiences of living with breast cancer. Method: The method is a literature review based on qualitative research with an approach inspired by meta-synthesis. Data collection was conducted in the CINAHL and PubMed databases, resulting in 11 articles. The articles were analyzed using an integrative analysis method. Results: The results identified four themes and eight subthemes describing women’s experiences of living with breast cancer. The themes included emotional and existential impact, changes in body and identity, psychological and cognitive consequences, and social and structural challenges. The disease evokes strong emotions such as fear, uncertainty, and hopelessness. Physical symptoms, such as fatigue, limit daily life, while bodily changes affect women’s femininity and self-image. Women require social and emotional support to cope with the disease and their changed life situation. Conclusion: Living with breast cancer presents a multifaceted challenge for women and affects their lives physically, psychologically, socially, and existentially. The disease brings about changes in self-image, daily life, and relationships, while women develop various strategies to cope with their changed life circumstances. The findings also highlight the importance of support in adapting to life with the disease.

Den här studien undersöker hur fenomenet uncanny valley påverkar romantiska scener i digitala spel. I takt med att spelgrafik har blivit mer realistisk har även kraven på trovärdiga känslouttryck ökat, särskilt i romantiska situationer där subtila visuella signaler är centrala. Tidigare forskning visar att små avvikelser i ansiktsuttryck, blick och kroppsspråk kan skapa obehag och minska spelarens inlevelse. Syftet är därför att identifiera vilka visuella animations element i romantiska spelscener som kan relateras till upplevelser av uncanny valley. Studien har genomförts som en kvalitativ innehållsanalys av romantiska cutscenes från spelen Heavy Rain (2010), Beyond Two Souls (2013), Mass Effect: Andromeda (2017) och Clair Obscur: Expedition 33 (2025), med filmscener som jämförelsematerial. Resultatet visar att uncanny valley främst uppstår när realistiska karaktärsmodeller kombineras med begränsade eller mekaniska animationer, särskilt i ansiktsmimik och ögonrörelser. Detta arbete bidrar med kunskap om hur romantiska spelscener kan göras mer trovärdiga.

Background: Palliative care is a central part of a nurse’s work and aims to alleviate suffering and promote quality of life for patients at the end of life. Previous research shows that nurses often encounter patients in need of palliative care and that this can be emotionally demanding. Lack of knowledge, insufficient experience, and difficulties in the palliative care setting can influence how nurses experience and provide palliative care.

Aim: To shed light on nurses’ experiences of providing care during the palliative care phase.

Method: Literature review of quantitative and qualitative research.

Findings: Nurses without specialized training or extensive experience in palliative care describe end-of-life care as both meaningful and emotionally demanding. A lack of knowledge, limited experience, and organizational barriers contribute to uncertainty and difficulties in providing person-centered care. Support from colleagues, supervision, and teamwork are important for enhancing confidence and the quality of care. The work also has a significant emotional impact, with various strategies used to manage emotional challenges associated with death and dying.

Conclusion: The study highlights nurses’ experiences of palliative care and shows that the work is characterized by both challenges and meaningfulness. Communication, emotional burden, lack of knowledge, and organizational limitations affect the ability to provide good care. Nurses still experienced the work as rewarding. The findings emphasize the need for increased competence, better conditions, and education to strengthen palliative care.

Bakgrunden till denna rapport grundas i tidigare forskning kring militära FPS-spel, procedurell retorik, och det långa samarbetet mellan militär och spelindustri. Målet med rapporten är att undersöka den procedurella retorik som används i Call of Duty:Modern Warfare-seriens kampanjlägen och vilka förväntade beteenden mellan spelare och NPC:er som spelens procedurella retorik förverkligar, med syfte att informera allmänheten och framtida spelutvecklare om hur Call of Duty: Modern Warfares konventioner påverkar spelens underliggande meddelanden. Spelen undersöks via en autoetnografisk metod, där forskarna själva spelar spelen, observerar och registrerar sina upplevelser, samt analyserar de mönster som har observerats. Resultatet av analysen tyder på ojämna förväntningar på spelare och allierade NPC:ers beteenden jämfört med motståndar-NPC:ers, där spelarens sida skildras som rättvisa beskyddare och motståndarnas sida skildras som blodsugna och utan etik. Framtida studier hade gynnats av intervjuer med oberoende spelare, intervjuer med inblandade spelutvecklare eller militär personal, och analys av en större variation av FPS-spel.

Background: A decision against CPR (cardiopulmonary resuscitation) means refraining from life-saving measures in the event of cardiac arrest. The decision is made by the responsible physician, with medical factors and ethical considerations playing a decisive role. Medical conditions, age and prognosis are weighed against the risk of suffering and a reduced quality of life following CPR. When making decisions, physicians typically strive to provide the best possible care for all patients, but family members may react differently to the decision. Team collaboration and clear communication with the patient and family members are essential, as a decision against CPR can be perceived as ethically complex and a sensitive issue.

Aim: To describe nurses’ experiences of encountering relatives’ experiences during a decision not to perform CPR.

Methods: The study was based on a qualitative interview design with an inductive approach. A convenience sampling was used, as the authors had connections to the participants’ workplace.The inclusion criteria were designed to ensure that participants could contribute relevant and reflective information. Data collection was conducted using semi-structured interviews based on an interview guide, with seven nurses participating. Qualitative content analysis was used to analyze the interviews, including both latent and manifest content being analyzed.

Results: The results were presented based on the following themes: General guidelines for decisions regarding no CPR, emotional reactions, and the importance of communication when explaining a no CPR decision, as well as their subthemes, which reflected how nurses perceived the experiences of family members. It became clear that most family members responded in a sensible and prudent manner, especially when information was provided well in advance and in a respectful way. The participants had also encountered situations where the decision was not accepted, often due to feelings of guilt and disappointment among family members.

Conclusion: The study showed that a decision against CPR was not merely a medical assessment but a complex process, in which suffering may be a factor in the decision making process. Suffering can be divided into illness-related suffering, life-related suffering and care-related suffering, all of which are taken into account in the decision. When patients and their families understand the patient’s suffering and quality of life, they are more likely to accept the decision.

Studien undersöker FPS-spelares prioritering mellan fysisk- och funktionell fidelitet i rökgranatseffekter till tävlingsinriktade FPS-spel. Fildelitet beskriver hur verklighetstroget ett element är. Relationen mellan fysisk- och funktionell fidelitet inom VFX är ännu obeforskat. Forskning om fidelitet i tillämpade spel har däremot funnit att fidelitet i utbildande syfte stärks när nivån på fidelitet är densamma, men att funktionell fidelitet är viktigare än fysisk.

Rökgranatseffekter med varierande fidelitetsgrad konstruerades och implementerades i spelprototyper som testades av FPS-spelare under enskilda intervjusamanhang. Vid intervjuerna besvarade deltagarna frågor kring rökgranatseffekterna.

Studien fann tydliga mönster kring FPS-spelares prioriteringar mellan fysisk- och funktionell fidelitet, där funktionell prioriteras över fysisk. Däremot anses rökgranatseffektens strategiska syfte vara viktigare för spelarna än både funktionell och fysisk fidelitet.

För vidare forskning föreslås en ökning av den ekologiska validiteten genom att skapa spelprototyper som mer troget efterliknar FPS-spel. Ytterligare forskning har relevans eftersom VDB-strukturen ständigt utvecklas och optimeras, vilket är väsentligt för spelutveckling.

Dataspel idag använder ofta färg för att kommunicera associerade spelfunktioner. Trots detta då finns det begränsad empirisk forskning om hur spelare kopplar färg till spelfunktion.

Syftet med denna studie är att utforska hur färg kopplas till spelfunktion i spel och hur detta kan kopplas till semantiska associationer till färgen.

Studien genomfördes med en enkätundersökning av olika färger, där deltagarna fick svara på vad de tror händer om deras karaktär rör artefakter, samt vad färgen påminner om. Målgruppen var vuxna som var vana spel och det 26 deltagare svarade på enkäten.

Resultatet visade att vissa färger har tydlig koppling till spelfunktion, exempelvis röd är kopplat till skada och hälsa, blå till mana och grön till både hälsa och gift.

Slutsatsen är att färg kan användas för att kommunicera funktion till spelare, men att betydelsen ofta är beroende av kontext.

This article examines the alignment and applicability of prominent technology adoption models in supporting the transition from Industry 4.0 to Industry 5.0, with a particular emphasis on the Operator 5.0 paradigm. Industry 5.0 extends beyond technological integration, emphasizing human-centricity, sustainability, and resilience. However, the practical implementation of Operator 5.0 initiatives faces significant barriers due to insufficient frameworks addressing these holistic dimensions. Through a systematic literature review of nine prominent technology adoption models (categorized into individual user-level, system-centered, and holistic theories), this research identifies their suitability for supporting human-centric, resilient, and sustainable Operator 5.0 initiatives. Findings reveal variability in model applicability across implementation phases (pre-implementation, implementation, post-implementation) and dimensions of Operator 5.0. A harmonized framework, termed the TAMOP 5.0 (Technology Adoption Models for Operator 5.0), was developed to map the strengths, limitations, and contextual applicability of these models using a three-round Delphi study concluded with consensus (a priori consensus rule). The TAMOP 5.0 is a strategic visual tool for practitioners and researchers, offering guidance to enhance employee acceptance, engagement, and successful adoption of Operator 5.0 initiatives. In an illustrative cobot-retrofit case, TAMOP 5.0 operationalizes phased adoption decisions by linking pre-change ergonomic/absence baselines, implementation support, and post-change KPI monitoring. The study concludes with recommendations for practical applications and highlights the need for further empirical validation of the proposed framework.

Purpose: This study explains how managers in family-owned real estate firms achieve flexibility in orchestrating their resources under conditions of uncertainty.

Design/methodology/approach: This paper draws on a single-case design, utilizing 21 interviews with top managers and archival material from 18 Swedish family-owned real estate firms to capture how the phenomenon of resource orchestration (RO) unfolds under uncertainty.

Findings: The results reveal how the family phenomenon can be understood as a key driver of the family firm’s RO mechanisms, shaping the RO activities of its managers.Originality/valueThree distinct RO configurations of family firm managers are identified: (1) flexible network structuring, (2) incremental flexibility and stakeholder-focused bundling and (3) cautious and societal flexible leveraging. These configurations explain how the family dimension enables the manager’s RO flexibility under conditions of uncertainty.